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Marcio Antonio De ,souza - One of the best experts on this subject based on the ideXlab platform.
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Labor analgesia : combined spinal-epidural block versus continuous epidural block in primiparous women
[s.n.], 2018Co-Authors: Marcio Antonio De ,souzaAbstract:Orientador: João Luiz de Carvalho Pinto e SilvaDissertação ( mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: JUSTIFICATIVA E OBJETIVOS: O trabalho de parto produz desconforto e dor intensa à maioria das parturientes. O método de eleição que seria ideal para produzir analgesia deveria reduzir ao máximo os inconvenientes e a dor provocados pelo trabalho de parto, permitindo que a mãe participasse ativamente e com prazer da experiência de dar à luz. A analgesia combinada raqui-peridural (ACRP) apresentaria, como vantagens, a possibilidade de instalação precoce, rápido início de ação analgésica, uso de baixas doses de anestésicos locais, associando-se a trabalhos de partos mais curtos, menor bloqueio motor e ofereceria maior satisfação à parturiente. A analgesia peridural contínua (APC) utilizaria doses maiores de anestésicos locais, produzindo maior bloqueio motor, mas deveria ser realizada em fases mais adiantadas do período de dilatação. O potencial atrativo da ACRP seria o de incorporar as vantagens da administração intratecal de fármacos de ação analgésica rápida, com a manutenção de acesso através de um cateter peridural, disponível continuamente para complementação com novas doses ou adição de outras drogas, minimizando as desvantagens apresentadas por ambas as técnicas. O estudo compara os desfechos maternos e perinatais com a utilização da ACRP e APC em parturientes primigestas. SUJEITOS E MÉTODOS Foi realizado um ensaio clínico aleatorizado com 128 gestantes primigestas em trabalho de parto, divididas em dois grupos de igual tamanho (grupo APC e grupo ACRP) admitidas no pré-parto de duas maternidades na cidade de Jundiaí - SP, sendo estudadas as seguintes variáveis: tempo de latência de instalação da analgesia, intensidade da dor ao longo da analgesia, tempo total decorrido até a completa dilatação do colo uterino, Índice de Apgar de primeiro e quinto minutos, tempo de resolução do parto, grau de bloqueio motor, efeitos adversos como náuseas, vômitos, prurido, hipotensão arterial e o grau de satisfação materna. ANÁLISE DOS DADOS: A análise dos dados foi feita através do teste de Mann-Whitney para as variáveis contínuas não paramétricas. Utilizou-se também teste exato de Fisher e teste qui-quadrado de Pearson para variáveis categóricas. RESULTADOS: Não houve diferenças entre os grupos em relação à velocidade de dilatação cervical, tempo para resolução do parto, parâmetros hemodinâmicos maternos, vitalidade do recémnascido, complementações analgésicas durante o trabalho de parto e parto. Ocorreu maior rapidez de instalação da analgesia no grupo da ACRP. Com relação ao bloqueio motor também se observou diferença estatística significativa entre os dois grupos, sendo menor no grupo de APC. CONCLUSÕES: As duas técnicas mostraram-se seguras e eficientes, porém a ACRP ofereceu uma analgesia mais rápida, com alívio mais precoce da dor. O bloqueio motor menos intenso no grupo APC proporcionou movimentação mais ativa no leito e uma coLaboração mais efetiva das gestantes durante o período expulsivo. A grande maioria das mulheres (97,6%) referiu satisfação com a analgesia recebida. As doses de anestésicos locais e opióides utilizadas em ambas as técnicas analgésicas propostas não produziram efeitos adversos maternos significativos e tampouco alteraram a vitalidade dos recém-nascidos dos dois grupos. Ambas as técnicas não mostraram qualquer predomínio de efeitos adversosAbstract: PROBLEM AND OBJECTIVES: The childbirth arouses distress and intense pain to most of the parturients. The ideal method of producing analgesia must reduce the Labor's pain and inconveniences to the utmost level, allowing the mother to participate on the delivery experience in an active and pleasant manner. The Combined Spinal-Epidural (CSE) analgesia offers the advantages of an early insertion, fast onset of analgesia, small dose of local anesthetic and reduced degree of motor block, being thus associated to short-time Labors and yielding greater satisfaction to the puerpera. Otherwise, the Continuous Epidural Analgesia (CEA) would require larger doses of local anesthetics and a larger motor block as well, but it would be applied only in advanced Stages of dilatation. The CSE analgesia has an attractive prospect, since it incorporates the advantages of the intrathecal administration of rapid onset pharmaceuticals, preserving this access through an epidural catheter that is uninterruptedly available for the insertion of other drugs and, at the same time, reducing the disadvantages that these both anesthesia techniques present. This study compares the combined spinal-epidural analgesia with the continuous epidural analgesia in primiparous parturients, through maternal and perinatal outcomes. APPROACH AND METHOD: 128 primiparous parturients in Labor were recruited for the study. They were separated into two equal groups (CEA group and CSE group) when they applied to two of the maternity hospitals in Jundiaí city, during the pre-Labor Stage. A random clinical rehearsal was accomplished and the following variables were analyzed: latency time for the analgesia onset, pain intensity after its onset, total time elapsed until the complete cervical dilation, Apgar Index at the 1st and 5th minutes, time for delivery conclusion, degree of motor block, level of sensitive block, adverse effects (such as nausea, vomiting, pruritus and arterial hypotension) and degree of motherly approval. Data Analysis: The analysis was performed through the Mann-Whitney non-parametric test for continuous variables. Fisher's exact test and Pearson's chi-square test were also employed. RESULTS: Concerning the compared variables on the speed of cervical dilation, time for delivery conclusion, maternal hemodynamic parameters, newborn's healthiness, complementary analgesia during Labor and Labor, there were no significant statistic differences between the two groups studied. However, the CSE group had a faster analgesia insertion. In relation to the motor block, a significant statistic difference was detected between the two groups, revealing a reduced motor block in the group that received the CEA. CONCLUSIONS: Both techniques were proved as safe and efficient, though the CSE analgesia offered a faster analgesia and sooner pain relief. Due to a less intense motor block, the parturients from the CEA group were able to accomplish an active movement and effective colLaboration during the expulsion Stage. The major part of the women (95,4%) expressed satisfaction with the analgesia that was applied. The doses of local anesthetics and opioids, contained in both analgesia techniques, did not cause considerable adverse effects on the mothers and did not either affect the newborns in any of the two groupsMestradoTocoginecologiaMestre em Tocoginecologi
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Labor analgesia : combined spinal-epidural block versus continuous epidural block in primiparous women
2017Co-Authors: Marcio Antonio De ,souzaAbstract:Resumo: JUSTIFICATIVA E OBJETIVOS: O trabalho de parto produz desconforto e dor intensa à maioria das parturientes. O método de eleição que seria ideal para produzir analgesia deveria reduzir ao máximo os inconvenientes e a dor provocados pelo trabalho de parto, permitindo que a mãe participasse ativamente e com prazer da experiência de dar à luz. A analgesia combinada raqui-peridural (ACRP) apresentaria, como vantagens, a possibilidade de instalação precoce, rápido início de ação analgésica, uso de baixas doses de anestésicos locais, associando-se a trabalhos de partos mais curtos, menor bloqueio motor e ofereceria maior satisfação à parturiente. A analgesia peridural contínua (APC) utilizaria doses maiores de anestésicos locais, produzindo maior bloqueio motor, mas deveria ser realizada em fases mais adiantadas do período de dilatação. O potencial atrativo da ACRP seria o de incorporar as vantagens da administração intratecal de fármacos de ação analgésica rápida, com a manutenção de acesso através de um cateter peridural, disponível continuamente para complementação com novas doses ou adição de outras drogas, minimizando as desvantagens apresentadas por ambas as técnicas. O estudo compara os desfechos maternos e perinatais com a utilização da ACRP e APC em parturientes primigestas. SUJEITOS E MÉTODOS Foi realizado um ensaio clínico aleatorizado com 128 gestantes primigestas em trabalho de parto, divididas em dois grupos de igual tamanho (grupo APC e grupo ACRP) admitidas no pré-parto de duas maternidades na cidade de Jundiaí - SP, sendo estudadas as seguintes variáveis: tempo de latência de instalação da analgesia, intensidade da dor ao longo da analgesia, tempo total decorrido até a completa dilatação do colo uterino, Índice de Apgar de primeiro e quinto minutos, tempo de resolução do parto, grau de bloqueio motor, efeitos adversos como náuseas, vômitos, prurido, hipotensão arterial e o grau de satisfação materna. ANÁLISE DOS DADOS: A análise dos dados foi feita através do teste de Mann-Whitney para as variáveis contínuas não paramétricas. Utilizou-se também teste exato de Fisher e teste qui-quadrado de Pearson para variáveis categóricas. RESULTADOS: Não houve diferenças entre os grupos em relação à velocidade de dilatação cervical, tempo para resolução do parto, parâmetros hemodinâmicos maternos, vitalidade do recémnascido, complementações analgésicas durante o trabalho de parto e parto. Ocorreu maior rapidez de instalação da analgesia no grupo da ACRP. Com relação ao bloqueio motor também se observou diferença estatística significativa entre os dois grupos, sendo menor no grupo de APC. CONCLUSÕES: As duas técnicas mostraram-se seguras e eficientes, porém a ACRP ofereceu uma analgesia mais rápida, com alívio mais precoce da dor. O bloqueio motor menos intenso no grupo APC proporcionou movimentação mais ativa no leito e uma coLaboração mais efetiva das gestantes durante o período expulsivo. A grande maioria das mulheres (97,6%) referiu satisfação com a analgesia recebida. As doses de anestésicos locais e opióides utilizadas em ambas as técnicas analgésicas propostas não produziram efeitos adversos maternos significativos e tampouco alteraram a vitalidade dos recém-nascidos dos dois grupos. Ambas as técnicas não mostraram qualquer predomínio de efeitos adversos. ;;Abstract:PROBLEM AND OBJECTIVES: The childbirth arouses distress and intense pain to most of the parturients. The ideal method of producing analgesia must reduce the Labor's pain and inconveniences to the utmost level, allowing the mother to participate on the delivery experience in an active and pleasant manner. The Combined Spinal-Epidural (CSE) analgesia offers the advantages of an early insertion, fast onset of analgesia, small dose of local anesthetic and reduced degree of motor block, being thus associated to short-time Labors and yielding greater satisfaction to the puerpera. Otherwise, the Continuous Epidural Analgesia (CEA) would require larger doses of local anesthetics and a larger motor block as well, but it would be applied only in advanced Stages of dilatation. The CSE analgesia has an attractive prospect, since it incorporates the advantages of the intrathecal administration of rapid onset pharmaceuticals, preserving this access through an epidural catheter that is uninterruptedly available for the insertion of other drugs and, at the same time, reducing the disadvantages that these both anesthesia techniques present. This study compares the combined spinal-epidural analgesia with the continuous epidural analgesia in primiparous parturients, through maternal and perinatal outcomes. APPROACH AND METHOD: 128 primiparous parturients in Labor were recruited for the study. They were separated into two equal groups (CEA group and CSE group) when they applied to two of the maternity hospitals in Jundiaí city, during the pre-Labor Stage. A random clinical rehearsal was accomplished and the following variables were analyzed: latency time for the analgesia onset, pain intensity after its onset, total time elapsed until the complete cervical dilation, Apgar Index at the 1st and 5th minutes, time for delivery conclusion, degree of motor block, level of sensitive block, adverse effects (such as nausea, vomiting, pruritus and arterial hypotension) and degree of motherly approval. Data Analysis: The analysis was performed through the Mann-Whitney non-parametric test for continuous variables. Fisher's exact test and Pearson's chi-square test were also employed. RESULTS: Concerning the compared variables on the speed of cervical dilation, time for delivery conclusion, maternal hemodynamic parameters, newborn's healthiness, complementary analgesia during Labor and Labor, there were no significant statistic differences between the two groups studied. However, the CSE group had a faster analgesia insertion. In relation to the motor block, a significant statistic difference was detected between the two groups, revealing a reduced motor block in the group that received the CEA. CONCLUSIONS: Both techniques were proved as safe and efficient, though the CSE analgesia offered a faster analgesia and sooner pain relief. Due to a less intense motor block, the parturients from the CEA group were able to accomplish an active movement and effective colLaboration during the expulsion Stage. The major part of the women (95,4%) expressed satisfaction with the analgesia that was applied. The doses of local anesthetics and opioids, contained in both analgesia techniques, did not cause considerable adverse effects on the mothers and did not either affect the newborns in any of the two groups
Marketta Tuppuraine - One of the best experts on this subject based on the ideXlab platform.
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persistent occiput posterior presentation a clinical problem
Acta Obstetricia et Gynecologica Scandinavica, 1994Co-Authors: Mikael Gardberg, Marketta TuppuraineAbstract:In order to find out how often Labor is complicated by persistent occiput posterior position, (OPP), and how it affects the course and outcome of Labor, the records of 3648 deliveries were reviewed, a frequency of 4.7% was found. Also, the amount of operative deliveries was surprisingly high, less than half of these cases were delivered without operative intervention. Total duration of Labor, Stage I1 of Labor were both significantly longer in the OPP group. The children in the OPP group also were significantly heavier (79 g) than the average birthweight in the whole material.
Mikael Gardberg - One of the best experts on this subject based on the ideXlab platform.
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persistent occiput posterior presentation a clinical problem
Acta Obstetricia et Gynecologica Scandinavica, 1994Co-Authors: Mikael Gardberg, Marketta TuppuraineAbstract:In order to find out how often Labor is complicated by persistent occiput posterior position, (OPP), and how it affects the course and outcome of Labor, the records of 3648 deliveries were reviewed, a frequency of 4.7% was found. Also, the amount of operative deliveries was surprisingly high, less than half of these cases were delivered without operative intervention. Total duration of Labor, Stage I1 of Labor were both significantly longer in the OPP group. The children in the OPP group also were significantly heavier (79 g) than the average birthweight in the whole material.
Bing Wang - One of the best experts on this subject based on the ideXlab platform.
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efficacy of transcutaneous electrical nerve stimulation combined with epidural analgesia in parturients during natural childbirth
Pain Clin J, 2018Co-Authors: Yan Lyu, Xiangjun Zhai, Bing WangAbstract:Objective To investigate the efficacy of transcutaneous electrical nerve stimulation(TENS) combined with epidural analgesia in parturients during natural childbirth. Methods Three hundred parturients were randomly divided into three groups: epidural Labor analgesia in parturients during active Stage(group A), epidural Labor analgesia in total Stages of Labor (group B) and TENS combined with epidural Labor analgesia in active Stage (group C). VAS at different times, Labor time, volume of postpartum hemorrhage and Apgar score were recorded. Venous blood samples were taken from all groups at the time in Labor and complete cervical dilation to test the concentrations of dynorphin (DYN), cortisol (Cor), norepinephrine (NE), epinephrine(E) and blood sugar. Results VAS in group B and C was significantly lower than that in group A at each time point in latent Stage of Labor (P 0.05). The concentration of DYN, Cor, NE, E and blood sugar increased in all groups at the time in complete cervical dilation as compared with the time in Labor (P<0.05). The concentration of DYN in group B and C was higher than that in group A at the time in complete cervical dilation, while the concentration of Cor, NE, E and blood sugar was lower (P<0.05). Conclusion TENS combined with epidural analgesia can improve the efficacy of Labor analgesia and shorten the Stage of Labor. The mechanism may be associated with the increase of plasma DYN content and the reduction of stress responses. Key words: Analgesia, obstetrical; Analgesia, epidural; Natural childbirth; Transcutaneous electrical nerve stimulation; Labor Stage; Acupuncture points
Perle Feldman - One of the best experts on this subject based on the ideXlab platform.
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preventing perineal trauma during childbirth a systematic review
Obstetrics & Gynecology, 2000Co-Authors: Erica Eason, Michel Labrecque, George A Wells, Perle FeldmanAbstract:Abstract Objective: To review systematically techniques proposed to prevent perineal trauma during childbirth and meta-analyze the evidence of their efficacy from randomized controlled trials. Data Sources: MEDLINE (1966–1999), the Cochrane Library (1999 Issue 1), and the Cochrane ColLaboration: Pregnancy and Childbirth Database (1995); and reference lists from articles identified. Search terms included childbirth or pregnancy or delivery, and perineum, episiotomy, perineal massage, obstetric forceps, vacuum extraction, Labor Stage–second. No language or study-type constraints were imposed. Study Selection: Randomized controlled trials (RCTs) of interventions affecting perineal trauma were reviewed. If no RCTs were available, nonrandomized research designs such as cohort studies were included. Studies were selected by examination of titles and abstracts of more than 1500 articles, followed by analysis of the methods sections of studies that appeared to be RCTs. Integration and Results: Eligible studies used random or quasirandom allocation of an intervention of interest and reported perineal outcomes. Further exclusions were based on failure to report results by intention to treat, or incomplete or internally inconsistent reporting of perineal outcomes. Final selection of studies and data extraction was by consensus of the first two authors. Data from trials that evaluated similar interventions were combined using a random effects model to determine weighted estimate of risk difference and number needed to treat. Effects of sensitivity analysis and quality scoring were examined. Results indicated good evidence that avoiding episiotomy decreased perineal trauma (absolute risk difference −0.23, 95% confidence interval [CI] −0.35, −0.11). In nulliparas, perineal massage during the weeks before giving birth also protected against perineal trauma (risk difference −0.08, CI −0.12, −0.04). Vacuum extraction (risk difference −0.06, CI −0.10, −0.02) and spontaneous birth (−0.11, 95% CI −0.18, −0.04) caused less anal sphincter trauma than forceps delivery. The mother’s position during the second Stage has little influence on perineal trauma (supported upright versus recumbent: risk difference 0.02, 95% CI −0.05, 0.09). Conclusion: Factors shown to increase perineal integrity include avoiding episiotomy, spontaneous or vacuum-assisted rather than forceps birth, and in nulliparas, perineal massage during the weeks before childbirth. Second-Stage position has little effect. Further information on techniques to protect the perineum during spontaneous delivery is sorely needed.
