Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block

Detalhes bibliográficos
Autor(a) principal: Braga,Angélica de Fátima de Assunção
Data de Publicação: 2019
Outros Autores: Carvalho,Vanessa Henriques, Braga,Franklin Sarmento da Silva, Pereira,Rosa Inês Costa
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista Brasileira de Anestesiologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000100007
Resumo: Abstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.
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spelling Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural blockSpinal anesthesiaCombined spinal-epiduralContinuous epiduralLabor analgesiaFetal and obstetric outcomesAbstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.Sociedade Brasileira de Anestesiologia2019-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000100007Revista Brasileira de Anestesiologia v.69 n.1 2019reponame:Revista Brasileira de Anestesiologia (Online)instname:Sociedade Brasileira de Anestesiologia (SBA)instacron:SBA10.1016/j.bjane.2018.08.003info:eu-repo/semantics/openAccessBraga,Angélica de Fátima de AssunçãoCarvalho,Vanessa HenriquesBraga,Franklin Sarmento da SilvaPereira,Rosa Inês Costaeng2019-01-04T00:00:00Zoai:scielo:S0034-70942019000100007Revistahttps://www.sbahq.org/revista/https://old.scielo.br/oai/scielo-oai.php||sba2000@openlink.com.br1806-907X0034-7094opendoar:2019-01-04T00:00Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)false
dc.title.none.fl_str_mv Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
title Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
spellingShingle Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
Braga,Angélica de Fátima de Assunção
Spinal anesthesia
Combined spinal-epidural
Continuous epidural
Labor analgesia
Fetal and obstetric outcomes
title_short Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
title_full Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
title_fullStr Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
title_full_unstemmed Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
title_sort Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block
author Braga,Angélica de Fátima de Assunção
author_facet Braga,Angélica de Fátima de Assunção
Carvalho,Vanessa Henriques
Braga,Franklin Sarmento da Silva
Pereira,Rosa Inês Costa
author_role author
author2 Carvalho,Vanessa Henriques
Braga,Franklin Sarmento da Silva
Pereira,Rosa Inês Costa
author2_role author
author
author
dc.contributor.author.fl_str_mv Braga,Angélica de Fátima de Assunção
Carvalho,Vanessa Henriques
Braga,Franklin Sarmento da Silva
Pereira,Rosa Inês Costa
dc.subject.por.fl_str_mv Spinal anesthesia
Combined spinal-epidural
Continuous epidural
Labor analgesia
Fetal and obstetric outcomes
topic Spinal anesthesia
Combined spinal-epidural
Continuous epidural
Labor analgesia
Fetal and obstetric outcomes
description Abstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.
publishDate 2019
dc.date.none.fl_str_mv 2019-01-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000100007
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1016/j.bjane.2018.08.003
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
dc.source.none.fl_str_mv Revista Brasileira de Anestesiologia v.69 n.1 2019
reponame:Revista Brasileira de Anestesiologia (Online)
instname:Sociedade Brasileira de Anestesiologia (SBA)
instacron:SBA
instname_str Sociedade Brasileira de Anestesiologia (SBA)
instacron_str SBA
institution SBA
reponame_str Revista Brasileira de Anestesiologia (Online)
collection Revista Brasileira de Anestesiologia (Online)
repository.name.fl_str_mv Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)
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