Mehmet ÇELİK, Lütfiye PİRBUDAK ÇÖÇELLİ, Ebru DİKENSOY, Özcan BALAT, Ünsal ÖNER, Saime ŞAHINÖZ

DOĞUM ANALJEZİSİNDE SÜREKLİ İNFÜZYON VE HASTA KONTROLLÜ ANALJEZİ YÖNTEMİNİN KOMBİNE SPİNAL EPİDURAL İLE EPİDURAL ANALJEZİ TEKNİKLERİNDE KLİNİK ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Amaç:Çalışmamızda doğum analjezisinde sürekli infüzyon ile hasta kontrollü analjezi yönteminin kombinespinal epidural (KSE) ile epidural (EP) analjezi tekniklerinde klinik etkinliklerini karşılaştırmayı amaçladık.Gereç ve Yöntemler:Etik kurul onayı ile, vajinal doğum yapması planlanan gebelik haftası 36. ile 42. haftalararasında, tek fetus, verteks presentasyonu olan 60 primigravid gebe çalışmaya alındı. Olgular rastgele iki grubaayrıldı (Grup 1: KSE grubu, Grup 2: EP grubu). KSE grubundaki gebelere 2.5 mg hiperbarik bupivakin ile 25 µgfentanil, toplam volüm 1 ml olacak şekilde verildi. Her iki grupta da kullanılmak üzere bupivakain (0.5 mg/ml) ilefentanil (1.5 µg/ml) içeren EP infüzyon solüsyonları hazırlandı. Ağrının derecesi vizüel analog skala (VAS)kullanılarak değerlendirildi. EP grubundaki gebelere hemen, KSE grubundaki gebelere ise intratekal dozunanaljezik etkisinin geçip VAS 4 olduğunda %0.125 bupivakain + 50 µg fentanil 10 ml yükleme dozu ve hemenardından 10 ml/saat bazal hız olacak şekilde EP infüzyon başlandı. İki gruptaki gebelerin ihtiyaç duyduklarında10 ml bolus doz uygulayabilmeleri sağlandı. Maternal ve fetal hemodinamik monitorizasyon yapıldı. Gebelereanaljezi başlangıç dozu verildikten sonra ağrının tamamen kaybolma süresi kaydedildi. Doğumun 1., 2. dönemsüreleri, EPinfüzyon süresi, total EPinfüzyon miktarı, tüketilen bupivakain miktarları, ek bolus doz gereksinimi,travayda ve postpartum dönemde gelişen yan etkiler kaydedildi.Bulgular:KSE grubunda analjezinin başlama süresi EP gruba göre çok kısaydı. KSE grubunda özellikledoğumun 1. evresinde servikal dilatasyonda hızlı artma ve doğumun süresinde kısalma gözlendi. KSE grubundaannenin hemodinamisi daha iyi korunduğu hipotansiyonun olmadığı, infüze edilen lokal anestezi (LA)miktarlarının çok düşük olduğu ve anne memnuniyetinin EPgruba oranla daha fazla olduğu gözlendi.Sonuç:Doğum analjezisinde sürekli infüzyon ile birlikte hasta kontrollü analjezi yönteminde KSE analjezininEPanaljeziye oranla daha güvenilir bir yöntem olduğunu söyleyebiliriz

Anahtar Kelimeler:

Kombine spinal epidural analjezi, epidural analjezi, doğum analjezisi

Comparison of Clinical Efficacies of Combined Spinal -Epidural versus Epidural Analgesia Techniques Performed with the Continuous Patient Controlled Infusion Method in Labor Analgesia

Objective: Our aim was to compare the clinical efficacies of combined spinal-epidural analgesia and epidural analgesia techniques performed with the continuous patient controlled infusion method in labor analgesia. Material and Methods: Following approval of the local ethics committee, 60 primigravid singleton pregnant women between 36 and 42 weeks of pregnancy, with vertex presentation and planned to give vaginal birth were included in the study. Patients were randomly divided into two groups. (Group 1: Combined spinal epidural analgesia (CSE) group and Group 2: Epidural analgesia (EP) group). Participants in CSE group were given a total volume of 1 ml, which is composed of 2.5 mg hyperbaric bupivacain and 25 µg fentanyl. EP infusion solutions were prepared with bupivacaine (0.5 mg/ml) and fentanyl (1.5µg/ml) for use in both groups. The degree of pain was assessed by using visual analogue scale (VAS).A10 ml loading dose consisting of 0.125% bupivacaine and 50 µg fentanyl was applied in the EP group. The CSE group received this dose when the VAS score reached 4 after the disapearance of the effect of intrathecal dose. EP infusions with a basal flow rate of 10ml/hr were given immediately after bolus doses. The pregnant women in both groups were able to apply themselves a bolus dose of 10 ml when needed. Maternal and fetal hemodynamic parameters were monitored. The period of time from the first application of analgesia until total dissappearance of the pain was recorded in all subjects. The durations of the first and second stages of labor, durations of EP infusions, total amounts of EP infusions, consumed bupivacaine amounts, any need for further bolus doses, adverse effects in the intrapartum and postpartum periods were recorded. Results: Initiation time of analgesia in subjects of CSE group was much shorter than the EP group. Especially, more rapid dilatation of cervix in the first stage of labor and a shorter labor time were observed in CSE group. Better preserved maternal hemodynamics without hypotension, lower amounts of infused local anesthetics and better patient satisfaction were also observed in theCSEgroup compared with the EPgroup. Conclusion: We can comment that CSE analgesia technique performed with continuous patient controlled infusion method is a more reliable method than EPanalgesia technique in labor analgesia.

Keywords:

Combined spinal-epidural analgesia, epidural analgesia, labor analgesia,

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