Research Article
BibTex RIS Cite

DOĞUMUN İKİNCİ EVRESİNDE EPİDURAL ANALJEZİDE BUPİVAKAİN İLE BUPİVAKAİN +FENTANİL KOMBİNASYONUNUN KARŞILAŞTIRILMASI

Year 2019, Volume: 52 Issue: 2, 123 - 127, 31.07.2019

Abstract

ÖZET



Amaç: Doğumun
2. evresinde epidural yolla uygulanan düşük konsantrasyondaki bupivakain +
fentanil ile daha yüksek konsantrasyondaki bupivakaini, analjezi kalitesi, bu
evrenin süresi ve seyri, çıkımda enstrümantasyon gereksinimi, hemodinamik
parametreler ile maternal ve neonatal yan etkiler bakımından karşılaştırmayı
amaçladık.



Gereç ve Yöntem: Doğum eylemi başlamış ve ağrı kontrolü isteyen 40 gebe rastgele 2 gruba
ayrıldı.  Epidural kateterizasyonu
takiben doğumun 1. evresinde her 2 gruba da 3cc %0.5 bupivakain +50mcg fentanil
+8cc %0.9’luk NaCl verildi. Doğumun 2. evresinde ise 1.gruba (n=20)4cc %0,5bupivakain
+ 4cc %0.9’luk NaCl,2.grub (n=20)ise 2cc %0.5bupivakain+ =.67 cc
fentanil(33.5mcg)+5.33cc%0.9’luk NaCl verildi. Çalışma süresince maternal
sistolodiastolik kan basınçları, kalp atım hızı ve fötal kalp atım hızları
izlendi. Ağrı ve aneljezinin etkinliği VAS ve iğne batırma yöntemleri ile
değerlendirildi, maternal ve neonatal yan etkiler kaydedildi.



Bulgular:
Birinci grupta aneljezi başlama süresi anlamlı olarak uzun (p<0.001), toplam
analjezi süresi ise anlamlı olarak kısa bulundu(p<0.001). İkinci evre
süresi(doğum eylemi)açısından gruplar arası fark bulunmadı (p>0.05). Doğumun
2. evresindeki epizyotomi tamiri için ek analjezik gereksinimi, 1.grupta 2.
gruba göre anlamlı olarak daha fazla bulundu.(p<0.001).



Sonuç: Doğumun
2.evresinde doğum ağrısını gidermede her iki uygulama yöntemi de yararlı
olmakla birlikte fentanil ilave edilen grupta daha iyi sonuçlar elde
edilmiştir.



 



 



Anahtar Kelimeler: Epidural analjezi, doğum, bupivakain,
fentanil



 

SUMMARY

 



Purpose: We aimed to compare analgesic
quality, progress and time of second stage labor, need to instrumental
delivery, hemodynamic parameters, maternal and fetal side effects of lower
concentration  bupivacain+fentanyl and
higher concentration bupivacaine used in second stage labor from epidural
route.



Materials and Method: Forty pregnant women in labor and
demanding pain relief were divided into 2 randomized groups. Following epidural
catheterisation,patients in both groups were given 3cc of 0.5% bupivacaine
+50mcg fentanyl+8cc  of 0.9 %Nacl in the
first stage labor. In the second stage labor, 4cc of 0.55 bupivacaine +4cc of
0.9 % NaCl were given to the first group of patients (n=20), while the second
group had 2cc of 0.5% bupivacaine +0.67 cc fentanyl (33.5mcg)+5.33 cc of 0.9 %
NaCl. .During the study maternal systolodiastolic blood pressures, heart rates
and fetal heart rates were monitored. Pain and effectiveness of analgesia were
evaluated by VAS and pin prick test and maternal and neonatal side effects were
recorded.



Results: İn the first group, duration to
the  onset  of 
analgesia was significantly (p<0.001)shorter. For the second stage of
labor there was  no significantly
(p<0.001) longer, while total analgesia 
time was significantly (p<0.001)shorter. For the second stage of
labor there was no significant 
difference (p>0.05) between the groups . Supplementary analgesic need
for episiotomy repair in the second stage was significantly higher in the first
group (p<0.001).



Conclusion: Althought both methods were
effective in relieving pain of the second stage of labor, the fentanyl added
group had better results.



 



 



Keywords: Epidural analgesia, labor,
bupivacaine, fentanyl

References

  • KAYNAKLAR1-Vincent RD, Chestnut DH. Epidural analgesia during labor. Am Fam Physician 1998,58(8):1785-92.2-Zhang J,Yancey MK, Klebaroff MA , Schwarz J, Schweitzer D. Does epidural analgesia prolong labor and increase risk of cesarean delivery?Am J Obstet Gynecol. 2001;185(1):128-34.3-Carrie LES, O’Sullivan M, Seegobin R.Epidural fentanyl in labour. Anaesthesia. 1981; 36(10): 965-9.4-Russel R, Reynolds F . Epidural infusion of low dose bupivacaine and opioid in labour. Anaesthesia.1996;51(3): 266-73.5-Atashkhoii S, Shobeiri JM, Negargar S. Effects of epidural analgesia with low-dose bupivacain and fentanyl on progress of labor and mode of delivery. MJIRI 2005;19(3): 207-11.6-Bromage PR. Epidural Analgesia.(Philadelpia(PA) WB Saunders;1978;.p.301-3207- Pirbudak L, Tuncer S, Koçoğlu H, Göksu S, Çelik C. Fentanyl added to bupivacaine 0.05% or ropivacaine0.05% in patient-controlled epidural analgesia in labour. Eur J Anaesthesiol. 2002;19(4):271-75.8-Naranayappa A, Gurulingaswamy S, Prabhakaraiah U, Kempegowda K, Hanumantharayappa NB. Practice of Labor Analgesia among Anesthesiologists Across India: Cross-sectional Study. Anesth Essays Res. 2018;12(3):651-56.9- Frölich MA. Obstetric Anesthesia In: Butterworth JF, Mackey DC, Wasnick JD; eds Morgan&Mikhail’s Clinical Anesthesiology 5th ed. Mc Graw Hill p.843-87610-Celleno D, Capopna G. Epidural fentanyl plus bupivacaine 0.125 percent for labour:analgezic effects. Can J Anaesth 1988;35(4):375-78.11- Chestnut DH, Laszewski LJ, Pollack KL,et al. Continuous epidural infusion of 0.0625% bupivacaine -0.0002% fentanyl during the second stage of labour. Anesthesiology. 1990: 72(4):613¬-18.12- Cohen S, Amar D, Pantuck CB, Pantuck EJ, Goodman EJ, Leung DHY. Epidural analgesia for labour and delivery; Fentanyl or sufentanyl ? CanJ Anaesth 1996;43(4):341-6.13- Craig MG, Grant EN, Tao W, Mc Intire DD, Leveno KJ. A randomized control trail of bupivacaine and fentanyl versus fentanyl –only for epidural analgesia during the second stage of labor. Anesthesiology 2015,122(1):172-7.14- Lyons G,Columb M,Hawthorne L, Dresner M. Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent. British Journal of Anaesrhesia 1997;78(5):493-7.15-Cohen SE, Tan S , Albright GA, Halpern J. Epidural fentanyl/bupivacaine mixtures for obstetric analgesia. Anaesthesiology. 1987;67(3):403-7.16-Justins DM, Francis D, Houlton PG, Reynolds F. A controlled trial of extradural fentanyl in labour.Br J Anesth. 1982,54(4):409-14.17- Jones G, Paul RA. Comparision of bupivacaine and bupivacaine with fentanyl in continuos extradural analgesia during labour.Br J Anaesth 1989:63(3):254-9.18-Reynolds F, O’Sullivan G. Epidural fentanyl and perineal pin in labour. Anaesthesia 1989,44(4):341-4.19-Wang TT1, Sun S, Huang SQ. Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2017;124(5):1571-80. 20-Maresh M, Choong KM, Beard RW. Delayed pushing with lumbar epidural analgesia in labour. Br J Obstet Gynaecol. 1983:90(7):623-7.
Year 2019, Volume: 52 Issue: 2, 123 - 127, 31.07.2019

Abstract

References

  • KAYNAKLAR1-Vincent RD, Chestnut DH. Epidural analgesia during labor. Am Fam Physician 1998,58(8):1785-92.2-Zhang J,Yancey MK, Klebaroff MA , Schwarz J, Schweitzer D. Does epidural analgesia prolong labor and increase risk of cesarean delivery?Am J Obstet Gynecol. 2001;185(1):128-34.3-Carrie LES, O’Sullivan M, Seegobin R.Epidural fentanyl in labour. Anaesthesia. 1981; 36(10): 965-9.4-Russel R, Reynolds F . Epidural infusion of low dose bupivacaine and opioid in labour. Anaesthesia.1996;51(3): 266-73.5-Atashkhoii S, Shobeiri JM, Negargar S. Effects of epidural analgesia with low-dose bupivacain and fentanyl on progress of labor and mode of delivery. MJIRI 2005;19(3): 207-11.6-Bromage PR. Epidural Analgesia.(Philadelpia(PA) WB Saunders;1978;.p.301-3207- Pirbudak L, Tuncer S, Koçoğlu H, Göksu S, Çelik C. Fentanyl added to bupivacaine 0.05% or ropivacaine0.05% in patient-controlled epidural analgesia in labour. Eur J Anaesthesiol. 2002;19(4):271-75.8-Naranayappa A, Gurulingaswamy S, Prabhakaraiah U, Kempegowda K, Hanumantharayappa NB. Practice of Labor Analgesia among Anesthesiologists Across India: Cross-sectional Study. Anesth Essays Res. 2018;12(3):651-56.9- Frölich MA. Obstetric Anesthesia In: Butterworth JF, Mackey DC, Wasnick JD; eds Morgan&Mikhail’s Clinical Anesthesiology 5th ed. Mc Graw Hill p.843-87610-Celleno D, Capopna G. Epidural fentanyl plus bupivacaine 0.125 percent for labour:analgezic effects. Can J Anaesth 1988;35(4):375-78.11- Chestnut DH, Laszewski LJ, Pollack KL,et al. Continuous epidural infusion of 0.0625% bupivacaine -0.0002% fentanyl during the second stage of labour. Anesthesiology. 1990: 72(4):613¬-18.12- Cohen S, Amar D, Pantuck CB, Pantuck EJ, Goodman EJ, Leung DHY. Epidural analgesia for labour and delivery; Fentanyl or sufentanyl ? CanJ Anaesth 1996;43(4):341-6.13- Craig MG, Grant EN, Tao W, Mc Intire DD, Leveno KJ. A randomized control trail of bupivacaine and fentanyl versus fentanyl –only for epidural analgesia during the second stage of labor. Anesthesiology 2015,122(1):172-7.14- Lyons G,Columb M,Hawthorne L, Dresner M. Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent. British Journal of Anaesrhesia 1997;78(5):493-7.15-Cohen SE, Tan S , Albright GA, Halpern J. Epidural fentanyl/bupivacaine mixtures for obstetric analgesia. Anaesthesiology. 1987;67(3):403-7.16-Justins DM, Francis D, Houlton PG, Reynolds F. A controlled trial of extradural fentanyl in labour.Br J Anesth. 1982,54(4):409-14.17- Jones G, Paul RA. Comparision of bupivacaine and bupivacaine with fentanyl in continuos extradural analgesia during labour.Br J Anaesth 1989:63(3):254-9.18-Reynolds F, O’Sullivan G. Epidural fentanyl and perineal pin in labour. Anaesthesia 1989,44(4):341-4.19-Wang TT1, Sun S, Huang SQ. Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2017;124(5):1571-80. 20-Maresh M, Choong KM, Beard RW. Delayed pushing with lumbar epidural analgesia in labour. Br J Obstet Gynaecol. 1983:90(7):623-7.
There are 1 citations in total.

Details

Primary Language Turkish
Journal Section Original research article
Authors

Meltem Bektaş

Alp Alptekin

Bülent Baltacı This is me

Türkay Çakan This is me

Nurten Ünal This is me

Publication Date July 31, 2019
Submission Date March 7, 2019
Published in Issue Year 2019 Volume: 52 Issue: 2

Cite

AMA Bektaş M, Alptekin A, Baltacı B, Çakan T, Ünal N. DOĞUMUN İKİNCİ EVRESİNDE EPİDURAL ANALJEZİDE BUPİVAKAİN İLE BUPİVAKAİN +FENTANİL KOMBİNASYONUNUN KARŞILAŞTIRILMASI. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. July 2019;52(2):123-127.