Doğumhanede son bir yılda uygulanmış olan ağrısız doğum uygulamalarının retrospektif olarak incelenmesi
Öz
Amaç: Kadınların hayatları boyunca yaşayabilecekleri en şiddetli ağrılardan biri doğum ağrısıdır. Epidural analjezi tekniği, doğum travayı sırasında oluşan ağrıyı gideren ve günümüzde en fazla kabul gören doğum analjezisi yöntemidir. Çalışmamızın amacı epidural analjezinin anne, fetüs ve doğum eylemi üzerine etkisini araştırmaktır.
Gereç ve Yöntem: 2015-2016 yılları arasında epidural doğum analjezisi uygulanan gebelerin dosyaları retrospektif olarak incelendi. Gebelerin demografik verileri, hemodinamik parametreleri, çocuk kalp atım sayıları, APGAR skorları, doğumun birinci ve ikinci evre süreleri, yardımlı doğum oranları, sezaryen oranları, yan etkiler, VAS değerleri, işlemden memnuniyetleri incelendi.
Bulgular: Epidural analjezi ile bupivakain ve fentanil kombinasyonu uygulanan gebelerde hemodinamik parametrelerde anormal değişiklik, yardımlı doğum sıklığı ve sezaryen oranında artış gözlemlemedik. Gebelerde yüksek oranda iyi analjezik etki elde edildiği ve doğum analjezisinden memnuniyet oranının oldukça yüksek olduğu bulundu. Epidural analjezinin çocuk kalp atım sayısıyla, 1. ve 5. dk APGAR skorlarına etkisi olmadığı gözlemlendi. Doğumun birinci ve ikinci evresini uzatmamanın yanında, fetüs üzerine yan etkisi olmadığı ve maternal yan etkilerin de düşük doz lokal anestezik ile opioid kombinasyonu uygulaması ile oldukça düşük olduğu görüldü.
Sonuç: Annede yoğun ağrı ve strese yol açan doğum sırasında, epidural analjezi uygulanması, uzman kişiler tarafından, uygun hastaya, uygun zamanlama ile yapıldığı takdirde ağrıyı azaltarak memnuniyeti yüksek, rahat bir doğum sağlamaktadır.
Anahtar Kelimeler
Kaynakça
- Chestnut D, Wong C, Tsen L, Kee WDN, Beilin Y, Mhyre J. Chestnut's Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia: Saunders; 2014:798-805.
- Sharma RM, Setlur R, Bhargava AK. Walking epidural: An effective method of labour pain relief. Med J Armed Forces India 2007;63(1):44-6.
- Torricelli M, Voltolini C, Conti N, et al. Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy. J Matern Fetal Neonat Med 2013;26(10):1016-9.
- Baranova A, Gowder SJ, Schlauch K, et al. Gene expression of leptin, resistin and adiponectin in the white adipose tissue of obese patients with non-alcoholic fatty liver disease and insulin resistance. Obes Surg 2006;16(9):1118-25.
- Antonakou A, Papoutsis D. The effect of epidural analgesia on the delivery outcome of induced labour: A retrospective case series. Hindawi Publishing Corporation Obstet Gynecol Int 2016;5740534:1-5.
- Orbach-Zinger S, Friedman L, Avramovich A, et al. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand 2006;50(8):1014-8.
- Vasudevan A. Pregnancy in patients with obesity or morbid obesity: Obstetric and anesthetic implications. Bariatric Times 2010;7(7):9-13.
- Brian S F. Anesthesiology Core Review, Part One: Basic Exam, Chapter 74: Epidural Test Dose, McGraw-Hill; 2014:213-7.
- Beilin Y, Guinn NR, Bernstein HH. Local anesthetics and mode delivery: Bupivacaine versus ropivacaine versus levobupivacaine. Anesth Analg 2007;105(3):756-63.
- Fernandez GJ, Serranu ML, Cobo B. A comparison of %0.0625 bupivacaine with fentanyl and %0.1 ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg 2001;92(5):1261-5.
- Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2011;12(1):1-4.
- Ramin SM, Gambling DR, Lucas MJ, et al. Randomized trial of epidural versus intravenous analgesia during labour. Obstet Gynecol 1995;86(1):626-32.
- Luria S, Matzkel A. Epidural anesthesia shortens of labor in singleton vertex presentasion spontaneous delivery. Asia Oceania J Obstet Gynecol 1991;17(3):944-50.
- Genc M, Sahin N, Maral J, et al. Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour? Am J Obstet Gynecol 2015;35(1):672-5.
- Gunaydin B. Doğum Analjezisi. Güncel Anestezi Ders Notları (Lecture Notes: Current Anesthesia) Ok G (Ed). Ankara: Derman Tıbbi Yayıncılık 2016;487-507.
- Leighton B L, Halpern S H. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review. Am J Obstet Gynecol 2002;186(5)69-77.
- Anand KL, Sarna R. A comparison of 0,1 % ropivacaine and 0,1 % bupivacaine with patient-controlled epidural analgesia for labor: A double blind study. Anaesth Pain & Intensive Care 2016;20(3):278-84.
- Salim R, Nachum Z, Moscovici R. Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction. Obstet Gynecol 2005;106(4):301-6.
- Halonen P, Sarvela J, Saisto T, Soikkeli A, Halmesmaki E, Korttila K. Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique. Acta Anaesthesiol Scand 2004;48(6):732-7.
- Rimaitis K, Klimenko O, Rimaitis M, Morkūnaitė A, Macas A. Labor epidural analgesia and the incidence of instrumental assisted delivery. Medicina (Kaunas) 2015;51(2):76-80.
- Gredilla E, Perez Ferrer A, Martinez B. Maternal satisfaction with the quality of epidural analgesia for pain relief in labor. Rev Esp Anestesiol Reanim 2008;55(3):160-4.
Retrospective analysis of the pain-free delivery practices performed at the delivery room over the last year
Öz
Aim: One of the most severe pain that women can experience throughout their lives is labor pain. Today, epidural analgesia technique is widely accepted method for labor analgesia that relieves pain that may occur during labor. Our aim was to investigate the effect of epidural analgesia on mother, fetus and labor.
Materials and Methods: Pregnant women who underwent epidural analgesia between 2015-2016 were retrospectively reviewed. Demographic data, hemodynamic parameters, pediatric heart rate, APGAR scores, first-second phase durations of birth, assisted delivery rates, cesarean rates, side effects, VAS, satisfaction of pregnancies were investigated.
Results: We did not observe any abnormal change in hemodynamic parameters, any increase in frequency of assisted labor, any increase in rate of cesarean section in cases of bupivacaine and fentanyl combination with epidural analgesia. Pregnancies were also found to have good analgesic effect at high doses and high rate of satisfaction with labor analgesia. It was observed that epidural analgesia had no effect on APGAR scores of 1-5 min with child heart rate. Without causing prolongation on first and second stages of labour, there was no side effect on fetus and maternal side effects were very low due to combination of low dose local anesthetic and opioid.
Conclusion: As a result, using epidural analgesia during labour, provides excellent maternal pain relief and a comfortable delivery with increased satisfaction of patient; if labour analgesia has been done by experienced anesthesiologist on appropriate patient, with appropriate timing.
Anahtar Kelimeler
Kaynakça
- Chestnut D, Wong C, Tsen L, Kee WDN, Beilin Y, Mhyre J. Chestnut's Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia: Saunders; 2014:798-805.
- Sharma RM, Setlur R, Bhargava AK. Walking epidural: An effective method of labour pain relief. Med J Armed Forces India 2007;63(1):44-6.
- Torricelli M, Voltolini C, Conti N, et al. Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy. J Matern Fetal Neonat Med 2013;26(10):1016-9.
- Baranova A, Gowder SJ, Schlauch K, et al. Gene expression of leptin, resistin and adiponectin in the white adipose tissue of obese patients with non-alcoholic fatty liver disease and insulin resistance. Obes Surg 2006;16(9):1118-25.
- Antonakou A, Papoutsis D. The effect of epidural analgesia on the delivery outcome of induced labour: A retrospective case series. Hindawi Publishing Corporation Obstet Gynecol Int 2016;5740534:1-5.
- Orbach-Zinger S, Friedman L, Avramovich A, et al. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand 2006;50(8):1014-8.
- Vasudevan A. Pregnancy in patients with obesity or morbid obesity: Obstetric and anesthetic implications. Bariatric Times 2010;7(7):9-13.
- Brian S F. Anesthesiology Core Review, Part One: Basic Exam, Chapter 74: Epidural Test Dose, McGraw-Hill; 2014:213-7.
- Beilin Y, Guinn NR, Bernstein HH. Local anesthetics and mode delivery: Bupivacaine versus ropivacaine versus levobupivacaine. Anesth Analg 2007;105(3):756-63.
- Fernandez GJ, Serranu ML, Cobo B. A comparison of %0.0625 bupivacaine with fentanyl and %0.1 ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg 2001;92(5):1261-5.
- Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2011;12(1):1-4.
- Ramin SM, Gambling DR, Lucas MJ, et al. Randomized trial of epidural versus intravenous analgesia during labour. Obstet Gynecol 1995;86(1):626-32.
- Luria S, Matzkel A. Epidural anesthesia shortens of labor in singleton vertex presentasion spontaneous delivery. Asia Oceania J Obstet Gynecol 1991;17(3):944-50.
- Genc M, Sahin N, Maral J, et al. Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour? Am J Obstet Gynecol 2015;35(1):672-5.
- Gunaydin B. Doğum Analjezisi. Güncel Anestezi Ders Notları (Lecture Notes: Current Anesthesia) Ok G (Ed). Ankara: Derman Tıbbi Yayıncılık 2016;487-507.
- Leighton B L, Halpern S H. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review. Am J Obstet Gynecol 2002;186(5)69-77.
- Anand KL, Sarna R. A comparison of 0,1 % ropivacaine and 0,1 % bupivacaine with patient-controlled epidural analgesia for labor: A double blind study. Anaesth Pain & Intensive Care 2016;20(3):278-84.
- Salim R, Nachum Z, Moscovici R. Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction. Obstet Gynecol 2005;106(4):301-6.
- Halonen P, Sarvela J, Saisto T, Soikkeli A, Halmesmaki E, Korttila K. Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique. Acta Anaesthesiol Scand 2004;48(6):732-7.
- Rimaitis K, Klimenko O, Rimaitis M, Morkūnaitė A, Macas A. Labor epidural analgesia and the incidence of instrumental assisted delivery. Medicina (Kaunas) 2015;51(2):76-80.
- Gredilla E, Perez Ferrer A, Martinez B. Maternal satisfaction with the quality of epidural analgesia for pain relief in labor. Rev Esp Anestesiol Reanim 2008;55(3):160-4.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 12 Şubat 2018 |
| Yayımlandığı Sayı | Yıl 2019 |