Labour analgesia with intrathecal fentanyl decreases maternal stress

Abstract

Labour analgesia with intrathecal fentanyl decreases maternal stressPurpose: Lumbar epidural analgesia (LEA) decreases rnatemal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephrine (Epi) and norepinephrine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA.Methods: Twenty-four healthy women in active labour received either 25 pg ITF (n = 12) or epidural lidocaine 1.5% (n= 12) for analgesia. Venous blood samples were collected before anaesthesia and at frye minute intervals for 30 min following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores 0/AS) to pain and pruritus were recorded at the same time.Results: Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyl(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01 ).Conclusion: We conclude that ITF is as effective as LEA in producing pain relief in the labouring patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epinephrine concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamine during labour.Objectif : l'analgEsie 6pidurale Iombaire (AI~L) diminue le stress matemeI dEterminE par le dosage des concentrations plasmatiques de catEcholamines. Le fentanyl sous-arachno'l'dien (FSA) procure une analg&ie efficace pendant le travail mais on ne conna?t pas son influence sur les concentrations matemelles d'EpinEphdne (I~PI) et de norEpinEphrine (N~:). Cette Etude visait ,~ determiner si le FSA diminuait le stress de la rhyme fa~on que I'AI~L.M&hodes : Vingt-quatre parturientes bien portantes en travail ont re<;u pour I'analg&ie soit du FSA 25 pg (n = 12) soit de la lidocai'ne Epidurale 1,5% (n= 12). Des &hantillons de sang veineux ont EtE recueillis avant I'anesthEsie et ,~ des intervalles de cinq minutes pendant 30 min awes ranesthEsie dans le but de mesurer I'I~PI et la N~ plasmatiques par chromatog~phie en phase liquide ,~ haute performance. En mEme temps, la pression art&ielle (PA), la frEquence cardiaque et les scores d'une Echelle visuelle analogique (E-r'VA) pour la douleur et le prurit Etaient enregistrEs. Conclusion : Le FSA est aussi ef~cace que I'AI~L pour soulager la douteur chez la parturiente en travail. Le fentanyl sous-arachno'idien diminue aussi les concentrations maternelles d'6pinEphrine, protEgeant ainsi la parturiente en travail des effets nocifs de concentrations excessives de catEcholamines.

Comparison of Different Bupivacaine and Fentanyl Combinations When Used with A Single Shut Spinal Block for Labor Analgesia

“…The combination of an opioid and a local anesthetic for intrathecal analgesia during labour has been well documented in previous studies across the world [8][9][10].…”

Incidental Hypoglycemia with Suspected High Spinal in a Case for Emergency Caesarian

“…With onset of labor pains blood sugars may increase because of increased release of cortisol and epinephrine, as the labor progresses there may be hypoglycemia and with pain relief with Neuraxial blockade significant decrease in catecholamine levels may prevent raise in blood glucose [7][8][9].…”

“…The neurogenic symptoms develop at a higher threshold {at a plasma glucose concentration of approximately 58 mg/ dL(3.2 mmol/l)} while neuroglycopenic symptoms and decline in cognitive function tests develop at significantly lower plasma glucose thresholds, approximately 51 and 49 mg/dL (2.8 and 2.7 mmol/l), respectively [3]. Hypoglycemia is treated by intravenous glucose (25g) followed by a glucose infusion guided by serial plasma glucose measurements [4].In one study by GH Movaseghi, 150 parturients were studied with Lidocaine spinal anaesthesia and serum Glucose levels showed a decrease in values compared to preoperative recordings [5].One case report by Crites J showed hypoglycaemia in a parturient with pre-existing type-2 diabetes mellitus after induction of a combined spinal-epidural (CSE) technique for labour analgesia [6].With onset of labor pains blood sugars may increase because of increased release of cortisol and epinephrine, as the labor progresses there may be hypoglycemia and with pain relief with Neuraxial blockade significant decrease in catecholamine levels may prevent raise in blood glucose [7][8][9].In our patient as she was not a known Diabetic and symptoms could have been masked by High spinal, we thought about hypoglycemia later as our primary concern was treating the effects of High spinal. …”

Labour analgesia effects on foetal heart rate. A mini-review

“…Cascio et al [54] also noted a reduction in maternal plasma epinephrine concentrations following both epidural and spinal analgesia, while plasma norepinephrine stayed the same or even increased slightly. They also observed faster decrease in plasma epinephrine in parturients who received spinal opioids when compared to epidural bupivacaine, which offers a possible explanation for the faster onset of FHR changes in CSE compared to epidural analgesia.…”