Djurdjevic Svraka Anita, Svraka Dragan, Pejic Dejan, Mrdja Vladimir
Faculty of Medicine, University of Banja Luka, Banja Luka, BIH.
Anesthesiology, Resuscitation, and Intensive Care, General Hospital Gradiska, Gradiska, BIH.
Cureus. 2024 Mar 1;16(3):e55322. doi: 10.7759/cureus.55322. eCollection 2024 Mar.
Even though the idea of painless birth is more than 100 years old, it is still underrepresented in some parts of the world despite progress in science, education, anesthesia, spinal and epidural needles, development of catheters, new drugs, and infusion pumps. Maternal care should basically be the safety of the patient (in this case two patients) and also provide all kinds of protection in the form of a multidisciplinary team with an anesthesiologist, especially when it comes to pain therapy and anesthesia for women in labor. In this direction, our hospital departments with low or moderate volume of annual births made the decision to educate ourselves for painless childbirth and contribute more to the care of women in labor. The enthusiasm and dedication of our clinical team prevailed and today we have a high standard of labor epidural service. The aim of this study was to evaluate the establishment of the epidural labor service by comparing the effects of epidural analgesia on labor pain and the course of labor. The secondary objectives were to compare satisfaction with epidural analgesia and the impact of epidural analgesia on the delivery mode.
This was a prospective observational hospital-based study conducted on 100 patients after the establishment of epidural service. Parturients who were signed to receive epidural analgesia formed Group A and parturients who did not request epidural analgesia formed Group B. All parturients are induced in the delivery room with a Bishop score of 5 or higher.
Pain intensity measured through the visual analog scale of pain (VAS score) was significantly lower in Group A (n 46) compared to Group B (n 50) at measured points of time (p<0.001) There was a fall in the mean VAS score in Group A from 7.94 to 3.86 within 20 minutes of the bolus dose and starting a continuous infusion. Labor progress according to the Bishop score and till the end of the second stage of labor, or to the transfer to the operating theatre, according to the monitored time in Group A was 176 minutes and it was lower in Group B with 155 minutes; however, by test of linearity we do not gain significance (p = 0.2. There were eight parturients in each group (17% vs 16%) who were indicated for surgical delivery. According to Pearson's correlation test for the outcome of labor between parturients receiving epidural analgesia and parturients without epidural analgesia (p = 0.8), we cannot say that epidural analgesia in labor is correlated with the outcome of surgical delivery.
Establishing a new hospital procedure such as an epidural painless service for childbirth in low or moderate-volume settings of annual births is very challenging. By evaluating epidural labor services in our hospital, we created the best environment for continuous improvement and long-term efficacy and safety of our analgesic techniques aimed at providing excellent care to mothers and their babies.
尽管无痛分娩的理念已有100多年历史，但尽管在科学、教育、麻醉、脊椎和硬膜外穿刺针、导管开发、新药以及输液泵等方面取得了进展，其在世界某些地区的应用仍然不足。孕产妇护理的根本应该是患者（在这种情况下是两名患者）的安全，并且应由包括麻醉师在内的多学科团队提供各种形式的保护，尤其是在为分娩妇女提供疼痛治疗和麻醉时。在这个方向上，我们医院年分娩量较低或中等的科室决定自行开展无痛分娩教育，并为分娩妇女的护理做出更多贡献。我们临床团队的热情和奉献精神取得了成效，如今我们拥有高标准的分娩硬膜外服务。本研究的目的是通过比较硬膜外镇痛对分娩疼痛和产程的影响来评估硬膜外分娩服务的建立情况。次要目的是比较对硬膜外镇痛的满意度以及硬膜外镇痛对分娩方式的影响。
这是一项在硬膜外服务建立后对100例患者进行的前瞻性观察性医院研究。签署接受硬膜外镇痛的产妇组成A组，未要求硬膜外镇痛的产妇组成B组。所有产妇在产房进行引产，Bishop评分≥5分。
通过视觉模拟疼痛量表（VAS评分）测量的疼痛强度，在各测量时间点，A组（n = 46）显著低于B组（n = 50）（p<0.001）。A组在推注剂量后20分钟内并开始持续输注时，平均VAS评分从7.94降至3.86。根据Bishop评分，A组直至第二产程结束或根据监测时间转至手术室的产程为176分钟，B组为155分钟，较短；然而，通过线性检验我们未得出显著差异（p = 0.2）。每组各有8名产妇（17%对16%）需要进行手术分娩。根据接受硬膜外镇痛的产妇与未接受硬膜外镇痛的产妇分娩结局的Pearson相关性检验（p = 0.8），我们不能说分娩时的硬膜外镇痛与手术分娩结局相关。
在年分娩量较低或中等的情况下建立一项新的医院程序，如分娩硬膜外无痛服务，极具挑战性。通过评估我们医院的硬膜外分娩服务，我们为持续改进以及旨在为母亲及其婴儿提供优质护理的镇痛技术的长期疗效和安全性创造了最佳环境。
