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OBJECTIVE: To investigate the effect of electroacupuncture (EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia. METHODS: According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group (37 cases), a sham-EA group (36 cases) and an epidural block group (31 cases). In the EA group, when the cervix opened up by 1 cm, Han's acupoint nerve stimulation apparatus was attached to bilateral Hegu (LI4) and bilateral Sanyinjiao (SP6) to achieve EA analgesia till the active stage (the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale (VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation (T1), 2 h of EA stimulation (T2), at the moment of epidural block (T3) and the complete open of the cervix (T6), the venous blood sample was collected to determine the concentration of beta-endorphin (beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded. RESULTS: There was no statistical difference in immediate of EA stimulation (T0) among the groups in VAS score (P>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately (P0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group (P0.05). CONCLUSION: Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.
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Objective To evaluate the treatment effects of epidural labor analgesia on syndecan-1 in patients with preeclampsia.Methods During Jan.,2016 and Dec.,2017,150 unipara females with preeclampsia and gestational age＞37 weeks were enrolled in the prospective cohort study.They were devided into intervention and control group (n =75 in each group) with and without epidural labor analgesia,based on whether epidural labor analgesia applications were made by the patients at the first examination of cervical dilation of 2 cm.The primary outcomes were mean change and change rate of syndecan-1 from baseline to 2 h post-treatment,and the secondary outcomes were visual analogue scale (VAS),IL-6 level and mean arterial pressure (MAP).Results Absolute change of syndecan-1 from baseline to 2 h post-baseline was (-11.49 ± 82.80) ng/mL in the intervention group and (45.09 ± 55.14) ng/mL in the control group,respectively.There was a significant difference in mean change of syndecan-1 between the two groups (P＜0.001).Similarly,the intervention group exhibited a greater reduction in change rate of syndecan-1 compared with the control group (P＜0.001).Moreover,the intervention group had greater reduction in VAS and MAP compared with the control group (P＜0.001 for both).There was no significant difference in IL-6 level between the two groups.Conclusions Epidural labor analgesia was associated with greater reduction in syndecan-1,VAS and MAP compared with the control condition.In contrast,administration of epidural analgesia did not significantly change IL-6 level.
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Objective To investigate the effects of epidural labor analgesia in latent phase on the puerperae and their newborns. Methods A total of 240 spontaneous parturient primiparae who received labor analgesia were selected from Decem-ber 2015 to January 2017 in Kaifeng Obstetrics and Gynecology Hospital. The primiparae were divided into observation group and control group,with 120 cases in each group. The puerperae in the observation group were performed with patient-controlled epidural analgesia(PCEA)in the latent phase,and the puerperae in the control group were performed with PCEA in the active phase. The puerperae received PCEA with 10 - 15 mL mixed liquor of ropivacaine mesylate and sufentanil citrate by self-con-trolled analgesia pump after epidural puncture. The time of the first stage of labor(T 1 ),the time of the second stage of labor (T2),visual analogue scale(VAS)score,uterine-incision delivery and the satisfaction degree of analgesia were observed. The blood pressure and heart rate of puerperae during the period of analgesia,and the neonatal Apgar score,the incidence of neo-natal asphyxia were compared between the two groups. Results The T1 and T2 of parturient in the observation group were sig-nificantly shorter than those in the control group (P < 0. 05),and the VAS score was significantly lower than that in the control group (P < 0. 05). There was no significant difference in blood pressure and heart rate between the two groups during the anal-gesia period (P > 0. 05). In the control group,the rate of cesarean section and the satisfaction of analgesia were 10. 83％ and 70. 83％ respectively;the rate of cesarean section and the satisfaction of analgesia were 3. 33％ and 95. 83％ respectively in the observation group. The rate of cesarean section in the observation group was significantly lower than that in the control group (χ2 = 5. 128,P < 0. 05),and the satisfactory rate of analgesia was significantly higher than that in the control group (χ2 = 27. 000,P < 0. 05). There was no significant difference in Apgar score of neonate between the two groups (P > 0. 05). Neonatal asphyxia rates in control group and observation group was 3. 0％ and 2. 5％ respectively;there was no significant difference in asphyxia rate between the two groups (χ2 = 0. 147,P > 0. 05). Conclusion The effect of epidural labor analgesia in latent phase is satisfactory. It can shorten the birth process and reduce the rate of cesarean section,and the maternal and in-fant risk is not increased.
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Objective To investigate whether preset epidural catheter and individualized onset time could improve the effect of epidural labor analgesia.Methods This was an open-label,random-ized,controlled trial.The nulliparae aged from 18 to 35 years,with single cephalic term pregnancy, were randomized into two groups.In the individualized group,epidural catheterization was performed at the beginning of labor (emergence of regular contractions and nearly disappearance of cervix),and epidural analgesia was initiated when asked by parturients and the numeric rating scale (NRS,a verbal rating score from 0 to 10 for pain,in which 0 represented no pain and 10 the worst pain imagi-nable)pain score ≥ 5 .In the control group,epidural analgesia was initiated at cervical dilation of≥ 1 cm.The primary outcome measures were the most severe NRS pain score during labor and the pro-portion of the most severe NRS pain score ≥ 7 evaluated at 24 hours after delivery.Results A total of 194 parturients completed the study,among whom 97 were in the individualized group and 97 in the control group.The most severe labor pain score during labor [median 9 (IQR 8-10)in the individ-ualized group vs 9 (8-10)in the control group,P=0.201]and the proportion having the most severe pain score ≥ 7 [94 cases (96.9%)in the individualized group vs 89 cases (91.8%)in the control group,P=0.1 2 1 ]did not differ significantly between the two groups.There were no significant differences of adverse events between the two groups.Conclusion For the nulliparae with single ce-phalic term pregnancy suitable for vaginal delivery, the effects of individualized epidural labor analgesia are comparable to that of traditional analgesia (beginning at cervical dilation of ≥ 1 cm). The individualized analgesia is safe.
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BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
Subject(s)
Female , Pregnancy , Analgesia , Anesthesia , Anesthesia, Epidural , Anesthesia, General , Anesthesia, Spinal , Bupivacaine , Cesarean Section , Epinephrine , Fentanyl , Hypotension , Incidence , Labor Pain , Lidocaine , Nausea , Prospective Studies , Shivering , VomitingABSTRACT
Objective To observe the effects of labor analgesia on the maternal and neonatal outcomes using Doppler ultrasound.Methods Fifty-nine primipara who required labor analgesia were included into group R,while 25 primipara who rejected labor analgesia were included into group N. The duration of labor process,bleeding volume,method of labor and the neonatal outcomes were re-corded and compared between the two groups.Moreover,pulsatility index (PI),resistance index (RI),and systolic/diastolic (S/D)were also recorded at the time before analgesia (T0 ),1 5 min after analgesia (T1 ),30 min after analgesia (T2 )and 60 min after analgesia (T3 )between the two groups. At the same time,RI,PI and S/D were also recorded in the group N.Results There were no signifi-cant differences in the duration of labor process,bleeding volume,method of labor and neonatal out-comes.And patients in the group R presented a decreasing trend in PI and S/D as well as an upward trend in RI after labor analgesia,but the differences were not significant.Furthermore,the changes in each index of the patients in group N were not significant,either.Conclusion Epidural labor analgesia does not affect maternal and neonatal outcomes,which can be safely used in clinic with little side effects.
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BACKGROUND: The purpose of this study was to identify the effect of fentanyl dose on the onset and duration of 0.2% ropivacaine. METHODS: Sixty-one nulliparous women with singleton vertex pregnancy who requested epidural labor analgesia were enrolled. Patients were administered randomly 0, 50, 100microgram of fentanyl with 10 ml of 0.2% ropivacaine (Group F0, F50 and F100, respectively). VAS pain scores were recorded 0, 5, 10, 15 min after epidural injection, after which they were recorded every 15 min. The onset and duration of analgesia were measured. Side effects such as, pruritus, motor blockade, and hypotension were recorded.Satisfaction scores, type of delivery, and neonatal outcomes were recorded. RESULTS: The onset of analgesia was at 8.5 +/- 3.4 min in Group F100, compared with 13.7 +/- 7.2 min in Group F0 and 13.6 +/- 5.3 min in Group F50 (P = 0.009). The duration of analgesia was 122.6 +/- 20 min in Group F100, compared with 72.3 +/- 21.2 min in Group F0 and 97.8 +/- 22.4 min in Group F50 (P = 0.000). There were significant differences in VAS pain scores and satisfaction scores among the three groups. There were no differences in the incidences of maternal side effects and operative delivery or neonatal outcomes. CONCLUSION: Fentanyl 100microgram was the most appropriate dose when combined with 0.2% ropivacaine due to the rapid onset and long duration of epidural labor analgesia.