IMEMR
66.92
Volume 1, Issue 1 (2020)                   J Clinic Care Skill 2020, 1(1): 31-36 | Back to browse issues page
Article Type:
Original Research |

Print XML PDF HTML


History

How to cite this article
Rad P, Hossein H, Delaviz H, Vanda R. Intrathecal Analgesia Versus Non-analgesia in Labor on Maternal and Neonatal Outcomes. J Clinic Care Skill 2020; 1 (1) :31-36
URL: http://jccs.yums.ac.ir/article-1-30-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rights and permissions
1- Midwifery Department, Medicine Feculty, Yasuj University of Medical Sciences, Yasuj, Iran
2- Anesthesiology Department, Medicine Faculty, Yasuj University of Medical Sciences, Yasuj, Iran‎
3- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran , delavizhamdi83@gmail.com
4- Gynecology Department, Medicine ‎Faculty, Yasuj University of Medical Sciences, Yasuj, Iran
* Corresponding Author Address: Anatomy Department, Medical School, Yasuj University of Medical Sciences‎, Yasuj, Iran. Postal Code: 7591994799
Abstract   (3035 Views)
Aims: Spinal analgesia is the most common method that provides pain relief during labor and controversy exists about its effect on the maternal and fetal among the women.
This study was conducted to determine the effect of intrathecal analgesia (ITA) on perineal laceration, duration of the first, second, and third stage of labor, and Apgar score.
Materials & Methods: Fifty primipara parturients with gestational age ≥37 weeks, in the active phase with cervical dilation of 3-4 cm participated in this randomized clinical trial study. Any participant with contraindication for vaginal delivery or spinal analgesia, the use of sedative drugs, and fetal malpresentation was excluded from the study. Based on whether they consented to ITA or Non-ITA parturients, they were divided to the ITA (n=25) and non-ITA (25) groups. The duration of the first, second, and third stage of labor, perineal laceration, birth weight, and Apgar scores were recorded and compared.
Results: Duration of the first stage of labor was significantly higher in the ITA (7.34±4.27) parturients compared to the non-ITA (5.52±2.1) group (p<0.039). There was no significant difference in the duration of third stage of labor between two groups (p>0.321). The number of Perineal laceration increased significantly in the ITA group compared to the non-ITA parturients (p=0.001). Neonatal outcomes demonstrated that there was no statistical significant difference in the first and fifth minute Apgar scores between 2 groups.
Conclusion: Intrathecal analgesia can provide effective analgesia for labouring patients, but prolong the first and second stage of labor.
Keywords:

References
1. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;(7):CD003766. [Link] [DOI:10.1002/14651858.CD003766.pub6]
2. Al-Kazwini H, Sandven I, Dahl V, Rosseland LA. Prolonging the duration of single-shot intrathecal labour analgesia with morphine. Scand J Pain. 2016;(13):36-42. [Link] [DOI:10.1016/j.sjpain.2016.06.010] [PMID]
3. Klomp T, van Poppel M, Jones L, Lazet J, Di Nisio M, Lagro-Janssen AL. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012;(9):CD009351. https://doi.org/10.1111/jebm.12009 [Link] [DOI:10.1002/14651858.CD009351.pub2]
4. Ahmad-Nia S, Delavar B, Eini-Zinab H, Kazemipour S, Mehryar AH, Naghavi M. Cesarean section in the Islamic Republic of Iran: Prevalence and some sociodemographic correlates. East Mediterr Health J. 2009;15(6):1389-98. [Link] [PMID]
5. Smith CA, Levett KM, Collins CT, Jones L. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev. 2012;(2):CD009290. [Link] [DOI:10.1002/14651858.CD009290.pub2]
6. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: An overview of systematic reviews. Cochrane Database Syst Rev. 2012;(3):CD009234. https://doi.org/10.1111/j.1756-5391.2012.01182.x [Link] [DOI:10.1002/14651858.CD009234.pub2]
7. Hughes D, Simmons SW, Brown J, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2003;(4):CD003401. [Link] [DOI:10.1002/14651858.CD003401]
8. Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348(4):319-32. [Link] [DOI:10.1056/NEJMra021276] [PMID]
9. Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor: A meta-analysis. JAMA. 1998;280(24):2105-10. [Link] [DOI:10.1001/jama.280.24.2105]
10. Bodner-Adler B, Kimberger O, Griebaum J, Husslein P, Bodner K. A ten-year study of midwife-led care at an Austrian tertiary care center: A retrospective analysis with special consideration of perineal trauma. BMC Pregnancy Childbirth. 2017;17:357. [Link] [DOI:10.1186/s12884-017-1544-9] [PMID] [PMCID]
11. Ferouz F, Norris MC, Arkoosh VA, Leighton BL, Boxer LM, Corba RJ. Baricity, needle direction, and intrathecal sufentanil labor analgesia. Anesthesiology. 1997;86(3):592-8. [Link] [DOI:10.1097/00000542-199703000-00010]
12. Rohrbach A, Viehweg B, Kühnert I, Köster A, König F. Effect of peridural analgesia on labor progress. Anaesthesiol Reanim. 2001;26(2):39-43. [German] [Link] [PMID]
13. Tao W,Grant EN, Craig MG, McIntire DD, Leveno KJ. Continuous spinal analgesia for labor and delivery: An observational study with a 23-gauge spinal catheter. Anesth Analg. 2015;121(5):1290-4. [Link] [DOI:10.1213/ANE.0000000000000903] [PMID]
14. Anabah T, Olufolabi A, Boyd J, George R. Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. S Afr J Anaesth Analg. 2015;21(1):19-22. [Link] [DOI:10.1080/22201181.2015.1013322]
15. Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology. 1998;88(2):355-61. [Link] [DOI:10.1097/00000542-199802000-00014] [PMID]
16. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: A systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S160-72. [Link]
17. Rimaitis K, Klimenko O, Rimaitis M, Morkūnaitė A, Macas A. Labor epidural analgesia and the incidence of instrumental assisted delivery. Medicina. 2015;51(2):76–80. [Link] [DOI:10.1016/j.medici.2015.02.002] [PMID]
18. Alexander JM, Sharma SK, McIntire DD, Leveno KJ. Epidural analgesia lengthens the friedman active phase of labor. Obstet Gynecol. 2002;100(1):46-50. https://doi.org/10.1097/00006250-200207000-00008 [Link] [DOI:10.1016/S0029-7844(02)02009-4]
19. Leighton BL, DeSimone CA, Norris MC, Ben-David B. Intrathecal narcotics for labor revisited: The combination of fentanyl and morphine intrathecally provides rapid onset of profound, prolonged analgesia. Anesth Analg. 1989;69(1):122-5. [Link] [DOI:10.1213/00000539-198907000-00023]
20. Yu SC, Kee WDN, Kwan ASK. Addition of meperidine to bupivacaine for spinal anesthesia for caesarean section. Br J Anaesth. 2002;88(3):379-83 [Link] [DOI:10.1093/bja/88.3.379]
21. Xin Q, Bai B, Liu W. The analgesic effects of oxytocin in the peripheral and central nervous system. Neurochem Int. 2017;103:57-64. [Link] [DOI:10.1016/j.neuint.2016.12.021] [PMID]
22. Myers RE, Williams MV. Lost opportunities for the prevention of fetal asphyxia: Sedation, analgesia, and general anaesthesia. Clin Obstet Gynaecol. 1982;9(2):369-414. [Link] [PMID]
23. Cappiello E, O'Rourke N, Segal S, Tsen LC. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia. Anesth Analg. 2008;107(5):1646-51. [Link] [DOI:10.1213/ane.0b013e318184ec14] [PMID]
24. Alexander JM, Lucas MJ, Ramin SM, McIntire DD, Leveno KJ. The course of labor with and without epidural analgesia. Am J Obstet Gynecol. 1998;178(3):516-20. [Link] [DOI:10.1016/S0002-9378(98)70431-4]
25. Behrens O, Goeschen K, Luck HJ, Fuchs AR. Effects of lumbar epidural analgesia on prostaglandin F2 alpha release and oxytocin secretion during labor. Prostaglandins. 1993;45(3):285-96. [Link] [DOI:10.1016/0090-6980(93)90053-A]
26. Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: A meta-analysis. Can J Anaesth. 2013;60(9):840-54. [Link] [DOI:10.1007/s12630-013-9981-z] [PMID]
27. Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth. 2010;105 Suppl 1:i50-60. [Link] [DOI:10.1093/bja/aeq311] [PMID]
28. Michelle JK, Osterman MHS, Joyce A, Martin MPH. Epidural and spinal anesthesia use during labor: 27-state reporting area. Natl Vital Stat Rep. 2011;59(5):1-16. [Link]
29. Zahra G. The effect of spinal block for labor analgesia in parturient in Iran. Proced Soc Behav Sci. 2011;28:919-22. [Link] [DOI:10.1016/j.sbspro.2011.11.169]
30. Robinson JN, Norwitz ER, Cohen AP, McElrath TF, Lieberman ES. Epidural analgesia and third- or fourth-degree lacerations in nulliparas. Obstet Gynecol. 1999;94(2):259-62. https://doi.org/10.1016/S0029-7844(99)00259-8 [Link] [DOI:10.1097/00006250-199908000-00020]
31. Palmer CM, Maciulla JE, Cork RC, Nogami WM, Gossler K, Alves D. The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia. Anesth Analg. 1999;88(3):577-81. https://doi.org/10.1097/00000539-199903000-00021 [Link] [DOI:10.1213/00000539-199903000-00021]
32. Zapp J, Thorne T. Comfortable labor with intrathecal narcotics. Mil Med. 1995;160(5):217-9. [Link] [DOI:10.1093/milmed/160.5.217]
33. Bakhsha F, Yousefi Z, Aryaie M, Jafari SY, Tofighi Rad A, Abbasi A. Comparison of Apgar score in new born by vaginal delivery and spinal anesthesia and its relationship with contributing factors. J Bas Res Med Sci. 2016;3(1):10-15. [Persian] [Link]
34. Lieberman E, O'donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S31-68. [Link]
35. Latifnejad-Roudsari R, Zakerihamidi M, Merghati-Khoei E, Kazemnejad A. Cultural perceptions and preferences of Iranian women regarding cesarean delivery. Iran J Nurs Midwifery Res. 2014;19(7 Suppl 1):S28-36. [Link] [PMID] [PMCID]
36. 36- Rahnama P, Mohammadi Kh, Montazeri A.Salient beliefs towards vaginal delivery in pregnant women: A qualitative study from Iran. Reprod Health. 2016; 13: 7. [Link] [DOI:10.1186/s12978-016-0120-5] [PMID] [PMCID]
37. Veličković I, Pujic B, Baysinger CW, Baysinger CL. continuous spinal anesthesia for obstetric anesthesia and analgesia. Front Med (Lausanne). 2017;4:133. [Link] [DOI:10.3389/fmed.2017.00133] [PMID] [PMCID]
38. Huckaby T, Skerman JH, Hurley RJ, Lambert DH. Sensory analgesia for vaginal deliveries: A preliminary report of continuous spinal anesthesia with a 32-gauge catheter. Reg Anesth. 1991;16(3):150-3. [Link] [PMID]
39. Wu JL, Hsu MS, Hsu TC, Chen LH, Yang WJ, Tsai YC. The efficacy of intrathecal coadministration of morphine and bupivacaine for labor analgesia. Acta Anaesthesiol Sin. 1997;35(4):209-16. [Link] [PMID]
40. Vasudevan A, Snowman CE, Sundar S, Sarge TW, Hess PE. Intrathecal morphine reduces breakthrough pain during labour epidural analgesia. Br J Anaesth. 2007;98(2):241-5. [Link] [DOI:10.1093/bja/ael346] [PMID]