Importance of neuroaxial methods of analgesia in modern obstetric practice

Abstract

The aim of the study is a comparative evaluation of the efficacy and safety of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods. Four groups of 40 women took part in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia, The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia.The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative influence of the anesthesia, the effect of analgesia on the fetus were also registered. Findings. Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an increase in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealed. There were no cases with score of ‘2’ of Bromagescale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of ‘1’ and ‘2’ were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion. Neuroaxialmethods provide a sufficient level of analgesia can reduce anomalies of labor and do not affect negatively the fetus. All presented methods of anesthesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.