Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000100005
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua

Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

Carlos Alberto de Figueiredo Côrtes; Cândido Amaral Sanchez; Amaury Sanchez Oliveira; Fernando Martinez Sanchez

http://dx.doi.org/10.1590/S0034-70942007000100005 Braz J Anesthesiol, vol.57, n1, p.39-51, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüências deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO: Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náuseas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES: Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor. Estudos clínicos com maior número de casos são necessários para avaliar diferença na incidência de cesarianas.

Palavras-chave

ANALGESIA, Obstétrica, ANESTÉSICOS, Local, ANALGÉSICOS, Opióides, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. METHODS: Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between analgesia and complete cervical dilation, duration of the expulsive phase, maternal hemodynamic parameters, and vitality of the newborn. Possible complications, such as respiratory depression, maternal hypotension, pruritus, nausea, and vomiting were also evaluated. The Student t test was used to compare the means and the Chi-square test was used to compare the number of pregnancies and type of labor. RESULTS: There were no statistically significant differences between both groups regarding the length of time between the beginning of analgesia and complete cervical dilation, as well as regarding the duration of the expulsive phase, incidence of cesarean section related to the analgesia, maternal hemodynamic parameters, and vitality of the newborn. CONCLUSIONS: Both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. Clinical studies with a larger number of patients are necessary to evaluate the differences in the incidence of cesarean sections.

Keywords

ANALGESIA, Obstetric, ANESTHETICS, Local, ANALGESICS, Opioids, ANESTHETIC TECHNIQUES, regional

Referencias

Torres MLA. Anestesia raqui-peridural combinada. Atual Anestesiol SAESP. 1998;4:69-79.

Ferez D. Atualização em Anestesiologia, vol. IX. 2004.

Cortes CAF, Oliveira AS, Petri RB. Estudo comparativo entre bupivacaína racêmica a 0,25% e bupivacaína com excesso enantiomérico de 50% (S75-R25) a 0,25%, associadas ao fentanil para analgesia de parto com deambulação da parturiente. Rev Bras Anestesiol. 2006;56:16-27.

Birnbach DJ. Analgesia for labor. N Engl J Med. 1997;337:1764-1766.

Norris MC, Fogel ST, Conway-Long C. Combined spinal-epidural versus epidural labor analgesia. Anesthesiology. 2001;95:913-920.

Frenea S, Chirossel C, Rodriguez R. The effects of prolonged ambulation on labor with epidural analgesia. Anesth Analg. 2004;98:224-229.

Collins RE, Davies DW, Aveling W. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labor. Lancet. 1995;345:1413-1416.

Chestnut DH, McGrath JM, Vincent RD Jr. Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor?. Anesthesiology. 1994;80:1201-1208.

Eisenach JC. Combined spinal-epidural analgesia in obstetrics. Anesthesiology. 1999;91:299-302.

Scull TJ, Hemmings GT, Carli F. Epidural analgesia in early labor blocks the stress response but uterine contractions remain unchanged. Can J Anaesth. 1998;45:626-630.

Shnider SM, Abboud TK, Artal R. Maternal catecholamines decrease during labor and after lumbar epidural anesthesia. Am J Obstet Gynecol. 1983;147:13-15.

Albright GA, Forster RM. Does combined spinal-epidural analgesia with subarachnoid sufentanil increase the incidence of emergency cesarean delivery?. . 1997;22:400-405.

Melzack R, Belanger E, Lacroix R. Labor pain: effect of maternal position on front and back pain. J Pain Symptom Manage. 1991;6:476-480.

Rawal R, Zundert AV, Holmstron B. Combined spinal-epidural technique. Reg Anesth. 1997;22:406-423.

Nageotte MP, Larson D, Rumney PJ. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med. 1997;337:1715-1719.

Vallejo MC, Firestone LL, Mandell GL. Effect of epidural analgesia with ambulation on labor duration. Anesthesiology. 2001;95:857-861.

Palmer CM, Cork RC, Hays R. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology. 1998;88:355-361.

Tsen LC, Thue B, Datta S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?. Anesthesiology. 1999;91:920-925.

Randomized Controlled Trial Comparing Traditional with Two "Mobile" Epidural Techniques. Anesthesiology. 2002;97:1567-1575.

Norris MC, Grieco WM, Borkowski M. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg. 1994;79:529537.

Abdou WA, Aveline C, Bonnet F. Two additional cases of excessive extension of sensory blockade after intrathecal sufentanyl for labor analgesia. Int J Obstet Anesth. 2000;9:48-50.

D'Angelo R. Should we administer epidural or spinal clonidine during labor?. Reg Anesth Pain Med. 2000;25:3-4.

Oliveira AS, Cortes CAF. Meningite após técnica combinada para analgesia de parto: Relato de caso. Rev Bras Anestesiol. 2002;52:515-516.

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