Ayşe KARCI, AYDIN TAŞDÖĞEN, Hülya KORKMAZ, Sabahattin ALTUNYURT, Serkan GÜÇLÜ, Hakan KİLERCİK, Nuray ÇETİNEL

Travay sürecinde hasta kontrollü epidural analjezi uygulanan gebelerde epidural ve kombine spinal-epidural analjezinin karşılaştırılması

Amaç: Doğum ağrılarının giderilmesinde Kombine Spinal - Epidural Analjezi (KSEA), Epidural Analjeziye (EA) bir alternatif olarak sunulmaktadır. Bu çalışmada, doğum eyleminin birinci evresinde KSEA veya EA uygulanan gebelerde analjezik yöntemin, doğum eylemi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve yöntem: Fakülte Etik Kurul onayı alındıktan sonra, ASA I-II'ye uyan 130 nullipar gebe kombine spinal-epidural (n=65) veya epidural (n=65) analjezi uygulanmak üzere çalışmaya alındı. KSEA grubunda, intratekal aralığa 20 $\mu$g fentanil + 1 mi %0,25 bupivakain uygulandı; epidural kateter yerleştirildi. Epidural grupta %0,125 bupivakain + 50 $\mu$g fentanil (toplam 10 ml) epidural aralığa enjekte edilerek analjezi sağlandı. Her iki grupta analjezi idamesinde Hasta Kontrollü Epidural Analjezi (HKEA) (%0,125 bupivakain + 2 $\mu$g/ml fentanil-10 ml bolus + 30 dk. kilit süresi) uygulandı. Serviksin dilatasyon ve efasman derecesi, fetus başının seviyesi, oksitosin infüzyon hızı, doğumun I ve II evre süreleri, yeni doğanın Apgar skoru, doğum şekli ve anne memnuniyeti; ayrıca hemodinamik parametreler, ağrı skorları, motor blok ve yan etkiler kaydedildi. Veriler istatistiksel olarak değerlendirildi. Bulgular: Oksitosin infüzyon hızının Grup EA'da 3-8. saatlerde daha yüksek olduğu (p

Anahtar Kelimeler:

Karşılaştırmalı çalışma, Anestezi, obstetrik, Anestezi, blok, Anestezi, spinal, Gebelik, Analjezi, epidural, Analjezi, obstetrik

Comparison of epidural and combined spinal-epidural analgesia in parturients receiving patient controlled epidural analgesia during labor

Objective: Combined spinal-epidural analgesia (CSEA) technique is proposed as an alternative to conventional epidural analgesia (EA) for pain of labor. In this study we aimed to compare the effects of CSEA with those of epidural analgesia on the progress of labor during the first stage of labor. Material and method: After approval by the local ethics committee, one hundred-thirty nulliparous parturients were randomly allocated to receive either CSEA (n=65) or EA (n=65) for labor. For combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 20 $\mu$g fentanyl were injected into the subarachnoid space and the epidural- catheter was inserted. The initial dose consisted of 0.125 % bupivacaine+50$\mu$g fentanyl in 10 ml of saline in the epidural group. Both groups received epidural top-ups of 10 ml 0.125 % bupivacaine+2µg/ml fentanyl via Patient Controlled Epidural Analgesia (PCEA) pump. Data were collected on cervical dilation, effacement, station, oxytocin infusion rates, length of 1st and 2nd stage of labor, Apgar scores, mode of delivery, mother satisfaction, hemodynamic parameters, side effects, pain and degree of motor block. Results: The mean cervical dilation rates and progress of station were significantly faster in patients receiving CSEA. Oxytocin infusion rates were higher in patients receiving EA. Progress of effacement, the incidence of side effects, and mode of delivery and Apgar scores were similar between groups. Parturients in both groups were equally satisfied. Conclusion: In nulliparous parturients, CSEA is associated with rapid progress of cervical dilation and station when compared to conventional EA; and can be an alternative to EA in our opinion.

Keywords:

Comparative Study, Anesthesia, Obstetrical, Anesthesia, Conduction, Anesthesia, Spinal, Pregnancy, Analgesia, Epidural, Analgesia, Obstetrical,

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