scholarly journals LABOUR ANALGESIA BY NEUROAXIAL BLOCKADE TECHNIQUE AND ITS LABOUR OUTCOME

2021 ◽  
pp. 10-13
Author(s):  
R.Shanthi Malar ◽  
V. Vijayalakshmi ◽  
P. Thenmozhi

BACKGROUND:Pain relief during labour is an important component of modern obstetric care and can be produced by neuraxial, systemic or inhalational analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique.A good labour analgesia should aim at good pain relief during delivery process,at the same time not causing foetal acidosis,ensures safe for both mother and the baby. AIM OF THE STUDY:To study the influence of epidural analgesia on maternal and neonatal outcome MATERIALS AND METHODS:The study was conducted in the depar tment of Obstet r ics and Gynecology,GOVT.Stanley Medical College,Govt.RSRM LYING IN HOSPITAL,CHENNAI over a period of eight months from July 2019 to February 2021. The study was performed in 120 selected subjects. The study subjects were divided based on intervention – labour analgesia into 2 study groups. In this study,change in vital parameters,fetal heart rate,assessment of pain score,Duration of first and second stage of labour,mode of delivery,APGAR score and the need for NICU admission were noted and recorded.Any complications during the course of labour were also recorded. RESULTS:In this study,there was no significant difference in the mean duration of first and second stage of labour in both the study and control groups.The mean Apgar score of babies at one minute was 7.02 and at 5 minutes was 8.07 in the labour analgesia group and showed no significance.Maternal satisfaction for the effect of epidural analgesia,60.00% of the patients of epidural analgesia, the incidence of satisfactory/very satisfactory experience was meaningfully and significantly more in labour analgesia group subjects compared to control group subjects by 30 % with a 2 fold increase. CONCLUSION: As per this study labour analgesia using neuroaxial blockade technique are more likely to encounter increasing maternal satisfaction and good quality labour pain reduction.

Author(s):  
Vasudha Sawant ◽  
Archana Kumbhar

Background: Experiencing labour pains and giving birth to infant is normal physiological process. Though it is a natural phenomenon, it produces severe pain which requires analgesia to relieve pain during labour. The objective of this study was to compare effects of low dose epidural analgesia verses no analgesia during labour on mother and fetus.Methods: Here in this study we have assessed effect of epidural analgesia on mother and fetus. Total we have taken 60 women in age group of 20-26 years with full term pregnancy (37-42 weeks). Those who have entered spontaneous labour with vertex presentation, without any previous uterine surgery, clinically adequate pelvis. We had divided these women in 2 groups, 30 were given epidural analgesia and 30 without any analgesia. Variables recorded were pain score during labour using VAS, duration of labour during each stage, mode of delivery, Apgar score of newborn at 1 minute and 5 minutes.Results: Present study shows that duration of first stage of labour in epidural and non-analgesia group are same. Second stage of labour is prolonged in epidural group than non-analgesia group. Both groups had normal APGAR score. Epidural analgesia is not associated with any change in mode of delivery. Visual analogue scale is good with epidural analgesia.Conclusions: There was no significant difference in first stage of labour in both group. Second stage of labour was slightly prolonged in EA group than control, but it was less than two hours. No harmful neonatal outcome in epidural analgesia.


Author(s):  
Lubna Javed ◽  
Anbrin Salick ◽  
Naheed Jamal Faruqi

Aims & Objectives: To study the effect of epidural analgesia (EA) in labour on the rate of instrumental deliveries Study Design: Clinical Trial / Case Control study. Study Settings: Labour ward of Jinnah Hospital, Lahore during one year period from July 2002 to June 2003. Patients and Methods: One hundred women in labor at term were divided into two equal groups. Group-I comprised of those women who were provided with epidural analgesia while group-II consisted of those women who had labour without the block. The anesthetist provided epidural analgesia using 0.125% bupivacaine and the obstetrician or midwife gave intermittent top-ups. Main Outcome Measures: The main outcome measures were the effect of epidural analgesia on the duration of second stage of labor and the rate of instrumental deliveries. The data was collected on a pre-designed proforma and was analyzed on computer software (SPSS). Ratio and proportions were calculated and Chi-square test was used to check significant association between the groups. P<.05 was considered statistically significant. Results: Gestational age, gravidity, duration of first stage of labour, and fetal outcome were comparable between the two groups. There was prolongation of second stage of labour (P < 0.05). 30% of the parturient in the group with epidural analgesia had second stage of <1 hour while there were 84 % of women in the control group who had second stage of <1 hour. 66% of the women in group I (EA) had duration of second stage of 1-2hours while in group-II 16% of women delivered in the same period. 4% of the women in the study group had second stage of >2hours while there was none (0.0%) who took >2hours in the control group. There was an increased rate of instrumental deliveries in patients with epidural analgesia (P<0.05). 40% of women had instrumental deliveries in the study group as compared to 10 % in the control group. Patient satisfaction was excellent among parturient given EA, 94 % of the parturient being very satisfied. Conclusion: Epidural analgesia along with an experienced anesthetist, a dedicated obstetrician and a trained midwife can convert the painful labour into a less stressful event. Although it prolongs the second stage of labour and increases the rate of instrumental deliveries yet its advantages of pain free labour, better psychological outcome and no significant complications outweigh these drawbacks.


Author(s):  
Pallavi Chauhan ◽  
S. D. Shirodkar

Background: Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of Epidural Analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Objective of this study was to study the effect of epidural analgesia on the duration of labour and pains.Methods: The present study was conducted on 60 women in the department of obstetrics and gynecology at Topiwala National Medical College, Mumbai during a period from October 2014 to January 2017. The women requesting EA were assigned as the study group (Group A - 30 cases) and women not receiving EA were included in the control group (Group B - 30 cases).Results: The duration of active phase of first and second stage of labour was found to be prolonged in patients who received EA as compared to control group. An increase in number of caesarean sections and requirement of oxytocin augmentation was found to be more in Group A as compared to Group B. There was no statistically significant difference in Apgar score of newborns at 1 min and 5 min in both the groups. The patients demanding epidural drug had better pain relief during labour. In Group A, 17% of patients and in Group B, 7% of patients had nausea and vomiting. Other side effects were minimal.Conclusions: Epidural analgesia is not a totally free of disadvantages, it is the most effective mode of pain relief available compared with other techniques. The addition of patient-controlled epidural analgesia and innovations using new technologies enhance patient satisfaction.


Author(s):  
Katta Jyothi ◽  
Senadhipathi Shakunthala

Background: Labour is a unique experience in a women’s life, it is a physiological but painful event. It is a dynamic and continuous process which cumulates in the birth of a healthy baby followed by expulsion of the placenta and the membranes. The objective of this study was to determine the effectiveness of amniotomy and oxytocin in terms of duration of labour, mode of delivery and maternal and fetal outcome.Methods: A non-randomized comparative study of accelerating effect of  oxytocin and amniotomy has been studied, in the age group of 19-30 years, who are admitted in obstetric ward 200 primigravidae were studied out of which 100 belongs to control group and 100 study group.Results: In the study series 93 cases had labour lasting less than 4 hours when compared to only. The mean total duration of labour is reduced in study group with a difference of 204 minutes. Quantity and duration of blood loss is significantly less in study group when compared to control group. There was no significant difference in terms of mode of delivery, maternal and foetal outcome between the two groups.Conclusions: Oxytocin infusion combined with amniotomy is safe and effective in accelerating the first and second stage of labour in apparently normal cases. No statistically significant adverse effects were noted with oxytocin infusion and amniotomy.


2008 ◽  
Vol 15 (01) ◽  
pp. 101-103
Author(s):  
MUHAMMAD ASGHAR KHAN ◽  
BILAL YASIN ◽  
MONA ZAFFAR ◽  
Shafi ur Rehman

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.


2021 ◽  
Vol 6 (1) ◽  
pp. 25-31
Author(s):  
Zawiah Kassim ◽  
Arifah Mokthar ◽  
Norliza Mohd Nor ◽  
Suhaina mohamad ◽  
Sarina Osman ◽  
...  

Introduction: For the past thirty years, patient-controlled epidural analgesia (PCEA) with basal infusion regimen has successfully improved the variable intensity of labour pain due to its advantage in allowing self-titration by the parturient. However, a recent review on programmed intermittent epidural bolus (PIEB) with PCEA regimen proved to be superior compared to PCEA with basal infusion, in terms of higher maternal satisfaction with longer duration of analgesia and lower local anaesthetic consumption. Following the introduction of PIEB at our institution, we did a study to compare maternal satisfaction, mode of delivery and neonatal outcome between these two methods of epidural labour analgesia. Methodology: We conducted a one-year retrospective analysis of data from obstetric analgesia service (OAS) record sheet and hospital information system evaluating outcomes after labour analgesia delivered by PCEA with basal infusion regimen (PCEA + basal infusion) and PIEB with PCEA regimen (PIEB+PCEA). The primary outcome was maternal satisfaction towards their labour analgesia. Other outcome parameters were the mode of delivery and neonatal Apgar scores. Outcomes were compared using independent t-test and Chi-square test. Result: There was no significant difference in maternal satisfaction between the two groups (P=0.398). However, a higher percentage of excellent satisfaction was found in the PIEB + PCEA group compared to that in the PCEA + basal infusion group (PIEB+PCEA 146/172 (84.9%) vs PCEA + basal infusion 138/171 (80.7%) respectively). There was no significant difference in the mode of delivery (P=0.296). However, PIEB+PCEA group had a higher percentage of spontaneous vaginal deliveries (PIEB+PCEA 87/172 (50.6%) vs PCEA + basal infusion 70/171 (40.9%) respectively) and a lower percentage of Caesarean deliveries (PIEB + PCEA 71/172 (41.3%) vs PCEA + basal infusion 87/171 (50.9%) respectively). Despite statistically significant differences found in Apgar scores in 1 minute (P=0.036), there was no significant difference in the scores at 5 minutes (P=0.107). Apgar scores and mean (SD) at 1 minute and 5 minutes for PIEB + PCEA were 7.77(0.85) and 8.91(0.55) respectively, and for PCEA + basal infusion the scores at 1 minute and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA regimen is a newer epidural delivery technique for labour analgesia in our centre, which produced a comparable outcome to PCEA with basal infusion regimen.


Author(s):  
Prashant K. Mishra ◽  
Anand K. Singh ◽  
Pragati Divedi

Background: Neuraxial techniques are the gold standard for intrapartum labour analgesia. Neuraxial labour analgesia using new local anaesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Multiple randomized controlled trials comparing epidural analgesia with systemic opioids, nitrous oxide or both have demonstrated lower internal pain scores and higher maternal satisfaction with neuraxial analgesia. The purpose of this study is to compare fentanyl and clonidine combination with levobupivacaine in terms of effect of epidural labour analgesia on fetal outcome and incidence of instrumental or caesarean delivery and duration of second stage of labour.Methods: A total of 50 primiparous with singleton pregnancy and vertex presentation and cervical dilatation of 3-5 cm were enrolled for the study in our hospital in department of obstetrics and gynecology. They were divided into group 1 and group 2 (25 patients in each group). Group 1 received 10 ml. of 0.125% isobaric levobupivacaine with 25µg fentanyl and group 2 received 10 ml of 0.125% isobaric levobupivacaine with 60 µg clonidine. Parturients were given epidural analgesia on numerical rating scale (NRS) Score >3. Breakthrough pain supplemented with 3-5 ml of 0.125% levobupivacaine. Data collected were demographic profile of the patients, analgesic qualities, 1st and 2nd stage labour duration, side effects and feto-maternal outcome.Results: Post treatment mean NRS were almost similar between two groups at all periods except at 15 minutes when it was significantly lower for group 2 (2.64±0.49). Onset of analgesia was earlier in group 2 (13.68±0.94) in comparison to group 1 (15.36±1.18) and was statistically significant.Conclusions: In conclusion Group 2 (levobupivacaine with clonidine) showed significant difference in early onset of analgesia but did not show any significant difference in duration of labour, maternal and fetal outcome and mode of delivery.


2020 ◽  
Vol 2 (1) ◽  
pp. 36-44
Author(s):  
Satyawan G. Damle ◽  
Ritika Bansal ◽  
Dhanashree D. Sakhare

Objective: To compare the success rate of different obturation procedures in primary mandibular second molars clinically and also by digital radiovisiography. Methods: A total of 40 children aged between 4-8 years with deeply carious mandibular second primary molars indicated for single session pulpectomy were selected. Canals were obturated with Metapex. The 3 study groups (Endodontic plugger, Handheld lentulospiral, Navi Tip syringe) were compared with the control group (reamer) both clinically and radiovisiographically. The data collected were statistically analyzed using Pearson’s Chi-square and Fisher’s exact test. Results: The use of Navi tip syringe led to the least number of voids followed by Endodontic plugger and Reamer and the highest number of voids was reported with Lentulospiral. Navitip presented maximum number of optimally filled cases followed by Endodontic plugger and Lentulospiral and least number of optimally filled cases with reamer. However, there was no statistically significant difference (p>0.05) in any of the groups with clinical (pain and tenderness to percussion) and radiographic parameters (presence or absence of voids and length of obturation). Conclusion: Within the limitations of the present study, though the clinical outcome was statistically insignificant, Navitip syringe exhibited encouraging results and is a promising option for obturation in primary teeth.


Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1569
Author(s):  
Tomislav Šušnjar ◽  
Ivana Kuzmić Prusac ◽  
Ivan Švagelj ◽  
Anđela Jurišić ◽  
Tomislav Šušnjar ◽  
...  

Background: The aim of this study was to compare consequences in single and triple testicular biopsy by biopty gun in pubertal rats using histological and immunohistochemical analysis. Methods: Thirty-two Sprague-Dawley male rats were used as the experimental model. The rats were randomly divided into three study groups. The rats from the first group (n = 12) received a single-biopsy of upper pole of the left testis, while the rats from the second group (n = 10) received triple-biopsy of upper and lower poles and lateral surface of left testis. The third group (n = 10) was a control group. On the eightieth day after the biopsy in all rats bilateral orchiectomy and funiculectomy were performed to obtain testicular tissue and sperm for analysis. The consequences of the puncture were observed by pathohistology, immunohistochemistry and semen analysis. Results: The results of the study showed lower percentage of sperm count (14.5 mill/mL vs. 16 mill/mL, p = 0.130), sperm motility (24.6% vs. 32.7%, p > 0.05), abnormal sperm (30% vs. 27%, p > 0.05), atrophic tubules (21% vs. 6%, p < 0.001), volume (1.7 mL vs. 2.28 mL, p < 0.01) and apoptotic index (1.56 vs. 1.19, p = 0.650) in the testes with a triple-biopsy compared to the testes with a single-biopsy. Semen analysis showed a borderline significant difference between the group with triple-biopsy where sperm count was lower than it in the control group (14.5 mill/mL vs. 17.5 mill/mL, p = 0.05). A single-biopsy has little effect on the testis, especially on overall fertility. A triple-biopsy showed higher degree of the testicular damage but without a significant impact on overall fertility. Semen analysis showed that single- and triple-biopsies did not have a significant effect on sperm count, motility and morphology. Conclusion: Biopty gun procedure is a cheap, simple and reliable method for testicular biopsy in rats without a significant effect on sperm count, motility and morphology.


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