[Epidural analgesia in the first stage of labor--is there an alternative?].

Autor:	Antipin ÉÉ, Uvarov DN, Nedashkovskiĭ ÉV, Kushev IP
Jazyk:	ruština
Zdroj:	Anesteziologiia i reanimatologiia [Anesteziol Reanimatol] 2014 Jan-Feb (1), pp. 18-22.
Abstrakt:	Objective: To evaluate the influence of epidural analgesia and lumbar paravertebral block on the structure of the delivery, the fetus and newborn, and the quality and duration of analgesia. Materials and Methods: Patients were randomized into three groups, 30 patients in each group. In the group-1 patients received epidural analgesia (EA), in the group-2--paravertebral block (PVB), in the group-3 patients refused pain relief in labor. Pain was assessed by VAS. Length of the first and second stage of labor the impact on the CTG and fetal blood gases from the umbilical cord of newborns in the first minute of life were fixed. Data were analyzed by Mann-Whitney U test and presented as median (25th-75th percentiles). Results: In both groups of patients in pain reduction was significant adjustment contractions and after 1 hour was 94.5% in EA, and PVB group--78.7% of the initial values. Under EA opening cervix was statistically significantly greater than in the PVB (192.5 (145, 302) vs 172.5 (112, 210) min) p < 0.05. Second stage of labor was also shorter in the PVB than in the EA (30.4 (10.2, 46.5) vs 59.8 (40.2, 81.5) min), in the control group it was--40.6 (21.3, 55.4) min, p < 0.05. PVB was observed in the group of more stable hemodynamics than in the EA for the entire period of observation. There were no adverse effects on the fetus and the newborn in the arms of the study. Conclusion: The proposed lumbar paravertebral block is simple to perform, is effective in reducing pain in the first stage of labor does not require continuous hemodynamic monitoring may be used for the treatment of birth dystocia and is a good alternative when the use of epidural analgesia during labor is limited.
Databáze:	MEDLINE
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