Alhowary Ala A, Altal Omar, Bani Hani Diab, Alrusan Anas, Ba Jusair Yaser Saleh, Al-Bataineh Rania, Al Sharie Ahmed, Aleshawi Abdelwahab
Department of Anesthesiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan.
Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
Local Reg Anesth. 2024 Dec 31;17:117-127. doi: 10.2147/LRA.S499370. eCollection 2024.
It has been recognized that the type of anesthetic and analgesic technique and the relative pain degree may have an influence on hyperglycemic-stress response to surgery. This comparative study aimed to assess glucose levels in both mothers and infants during normal vaginal delivery. This study aimed to investigate this stress response between mothers who received parenteral analgesia versus epidural analgesia (EA) as an objective reflection for pain response.
One hundred and seventeen patients participated in this prospective comparative study. They were categorized into two groups: parenteral analgesia group (who received subcutaneous morphine) and EA group. The primary outcome was to measure the difference in blood glucose level before delivery (at 3 cm cervical dilation), at full dilation, and at the third stage of labor and compare these values between both groups. The secondary outcome was to assess the factors affecting the glycemic stress response in mothers and neonates.
The change in maternal glucose level at full dilation and after delivery were significantly lower in the EA group. Neonatal glucose levels were not significantly different between the two groups. The change in maternal glucose level was influenced by the number of gravity and miscarriages. Neonatal glucose levels were associated with the gestational age of delivery, birth weight, and maternal glucose level at full cervical dilation.
EA appears superior to parenteral opioids analgesia, providing better pain management and subsequent lower stress response levels for mothers during vaginal delivery. These findings highlight the importance of the choice of analgesia during labor to optimize maternal well-being. Optimizing maternal factors (such as glycemic response) and neonatal factors (such as prematurity and birth weight) may influence the stress response of the neonates.
人们已经认识到麻醉和镇痛技术的类型以及相对疼痛程度可能会对手术中的高血糖应激反应产生影响。这项比较研究旨在评估正常阴道分娩过程中母亲和婴儿的血糖水平。本研究旨在调查接受非肠道镇痛与硬膜外镇痛（EA）的母亲之间的这种应激反应，作为疼痛反应的客观反映。
117名患者参与了这项前瞻性比较研究。他们被分为两组：非肠道镇痛组（接受皮下注射吗啡）和EA组。主要结局是测量分娩前（宫颈扩张3厘米时）、宫口开全时和第三产程时的血糖水平差异，并比较两组之间的这些值。次要结局是评估影响母亲和新生儿血糖应激反应的因素。
EA组在宫口开全时和分娩后的母亲血糖水平变化显著较低。两组之间的新生儿血糖水平没有显著差异。母亲血糖水平的变化受产次和流产次数的影响。新生儿血糖水平与分娩孕周、出生体重以及宫颈完全扩张时的母亲血糖水平相关。
EA似乎优于非肠道阿片类药物镇痛，在阴道分娩期间为母亲提供更好的疼痛管理以及随后更低的应激反应水平。这些发现突出了分娩期间镇痛选择对优化母亲健康的重要性。优化母亲因素（如血糖反应）和新生儿因素（如早产和出生体重）可能会影响新生儿的应激反应。
