Analgesia en trabajo de parto

Analgesia epidural para el trabajo de parto: técnicas actuales  Epidural analgesia for labor: Current techniques Marcos Silva, Stephen H Halpern Department of Anesthesia, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada Local and Regional Anesthesia 2010;3:143-152. Introduction Epidural analgesia is an extremely effective and popular treatment for labor pain. In Canada, the epidural rate varies between the provinces from 30% to 69%.1 The use of epidural analgesia in the US has tripled between 1981 and 2001, with 60% of women using this technique in large hospitals.2 In this review, we will outline a brief history of the use of epidural analgesia and examine the current techniques of initiation and maintenance of pain relief. We will also discuss the main complications and contraindications for this method of analgesia. In this review, epidural analgesia refers to local anesthetics and adjuvants injected into the epidural space. Spinal anesthesia refers to local anesthetic, with or without adjuvants, injected into the subarachnoid space. Combined spinal-epidural analgesia includes analgesia initiated with an intrathecal injection and placement of an epidural catheter to provide a route for additional drug. Neuraxial analgesia includes spinal, epidural, and combined spinal-epidural analgesia. http://www.dovepress.com/epidural-analgesia-for-labor-current-techniques-peer-reviewed-article-LRA   Analgesia epidural para trabajo de parto usando bupivacaína y clonidina Epidural labour analgesia using Bupivacaine and Clonidine. Syal K, Dogra R, Ohri A, Chauhan G, Goel A. Senior Residents, Department of Anaesthesia, IGMC, Shimla (H.P.). J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):87-90. Abstract BACKGROUND: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. PATIENTS #ENTITYSTARTX00026; METHODS: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacaine (0.125%) alone, whereas Group II received bupivacaine (0.125%) along with Clonidine (60 μg). 10 ml of 0.125% bupivacaine was injected as first dose and further doses titrated with patient relief (Numerical Rating Scale <3). Top ups were given whenever Numerical Rating Scale went above 5. RESULTS: There was statistically significant prolongation of duration of analgesia in Group II, with no difference in duration of labour, ambulation, incidence of instrumentation and caesarean section or foetal outcome. Also clonidine gave dose sparing effect to bupivacaine and there was better patient satisfaction without any significant side effects in Group II. CONCLUSION: Clonidine is a useful adjunct to bupivacaine for epidural labour analgesia and can be considered as alternative to opioids. http://www.joacp.org/temp/JAnaesthClinPharmacol27187-7917801_021157.pdf  Comparación entre ropivacaína 0.08% y levobupivacaína 0.06% para analgesia epidural en nulíparas durante el trabajo de parto: estudio retrospectivo en un centro Comparison between 0.08% ropivacaine and 0.06% levobupivacaine for epidural analgesia during nulliparous labor: a retrospective study in a single center. Lee HL, Lo LM, Chou CC, Chuah EC. Department of Anesthesiology, Chang Gung Memorial Hospital, Songshan District, Taipei, Taiwan. Chang Gung Med J. 2011 May-Jun;34(3):286-92. Abstract BACKGROUND: Levobupivacaine and ropivacaine are new local anesthetics that have effects similar to bupivacaine. However, the relative potency of these two drugs is controversial. The purpose of this retrospective study was to assess whether a combination of 0.06% levobupivacaine and 0.0002% fentanyl had the same effects as 0.08% ropivacaine and 0.0002% fentanyl on the mode of delivery and other obstetric outcomes when used for epidural analgesia of labor in nulliparous women. METHODS: Computer records of 392 Asian nulliparous parturients, who had presented with spontaneous labor or spontaneous rupture of the membranes, and had received epidural analgesia were retrospectively reviewed. Of these, 193 received 0.08% ropivacaine and 199 received 0.06% levobupivacaine. Fentanyl (0.0002%) was used in both regimens. RESULTS: There were no significant differences in the mode of delivery, duration of labor, or neonatal outcome between the two groups. In the levobupivacaine group, the parturients required top-up boluses of local anesthetics more frequently (1.4 ± 1.6 vs. 0.9 ± 1.3, p< 0.0001), and the incidence of temporary maternal fever (25 % vs. 15%, p = 0.024) and the cost of local anesthetic were higher (292 ± 183 NTD vs. 146 ± 104 NTD, p< 0.0001). However, the amount of local anesthetic administered during labor was lower (79 ± 49 mg vs. 114 ± 81 mg, p< 0.0001) than for the ropivacaine group. CONCLUSIONS: 0.06 % levobupivacaine was as effective as 0.08% ropivacaine, when both were used with 0.0002% fentanyl for labor epidural analgesia of nulliparous women http://memo.cgu.edu.tw/cgmj/3403/340307.pdf

Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org