Analysis of the use of regional techniques for analgesia during childbirth

Abstract

Purpose - to analyze and compare regional analgesia methods: dural puncture epidural (DPE), combined spinal-epidural (CSE) and epidural analgesia (EA), assessing the quality and effectiveness of analgesia, the effect of the methods on hemodynamics, the effect on the fetus, the frequency of occurrence complications. Materials and methods. 120 women in labor who underwent analgesia during childbirth were examined. The women were divided into three groups (40 people in each): 1 - DPE, 2 - CSE, 3 - EA. An analysis of the effectiveness and quality of analgesia, the effect on the woman’s systemic and central hemodynamics, and the effect on the fetus was performed by evaluating the cardiotocogram (CTG). Assessment of the condition of the newborn was carried out according to the Apgar scale, determination of lactate and pH of umbilical cord blood. An analysis of complications from the mother and child was performed. Results. There was a significant difference in the time of reaching pain with a visual analogue scale (VAS) pain score <1 between the groups DPE (11.4±3.3 min), CSE (4.4±2.1 min), EA (21.5±7.2 min) (p<0.01). In the EA group, the frequency of insufficient analgesia (17.5%) and unilateral blockade up to 30 min (25.0%) was significantly higher than in the DPE (0%) and CSE (0%) groups (p<0.01). Hypotension was in the CSE group at the level of 20%, which is 12.5% (p<0.05) more often than in the EA and DPE groups. A significant decrease in cardiac output was found in the CSE group by 9.6% (p<0.01) and 15.4% (p<0.01) compared to EA and DPE. The need to determine lactate from the anterior head to verify the condition of the fetus in the CSE group (12.5% of cases, which is 10% higher compared to the EA and DPE groups; p<0.05). No significant difference was found in the condition of children after birth. Itching and nausea are more common in the CSE group. Post dural puncture headache was not detected in any group. Conclusions. The data analysis showed that the DPE technique showed a high efficiency of labor analgesia with a low incidence of unilateral block. CSE is associated with a higher incidence of hypotension and pathological changes in fetal heart rate on CTG compared to DPE and EA methods. The use of the DPE method does not increase the frequency of complications for the mother and child. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.