How to Cite
1.
Solar Del Valle T. Combined spinal-epidural versus epidural analgesia during labor: fetal effects and delivery outcomes. Rev.méd.sinerg. [Internet]. 2019Jun.1 [cited 2024Jul.22];4(6):5 - 13. Available from: https://revistamedicasinergia.com/index.php/rms/article/view/236
Abstract
Pain during labor may elicit different responses that can be detrimental both to the mother and the fetus. Among the different methods used to relieve pain during childbirth, neuraxial analgesia has proven to be the most effective. The epidural technique and the combined spinal-epidural are the most common techniques for administrating neuraxial analgesia. Several studies have analyzed the adverse reactions of these techniques, by comparing their effects on uteroplacental perfusion measured by uterine contractions, fetal heart rate and the need to perform an emergency cesarean delivery due to these alterations. Comparing the results in these studies, it was demonstrated that, even though patients that had received a combined spinal-epidural presented greater fetal heart rate alterations, this did not increase perinatal complications significantly. These alterations have shown to be transient and, if recognized and treated promptly, do not increase maternal or fetal morbidity and mortality.
Keywords
anesthetics. analgesia. heart rate. opioids. parturition.
References
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2.Lowe N. The nature of labor pain. American Journal of Obstetrics and Gynecology. 2002; 186(5): S16-S24.https://doi.org/10.1016/S0002-9378(02)70179-8
3.Chu A, Ma S, Datta S. Analgesia in labour and delivery. Obstetrics, Gynaecology & Reproductive Medicine. 2017; 27(6): 184-190.https://doi.org/10.1016/j.ogrm.2017.04.001
4.O’Neal M. Obstetric anaesthesia: what a neurologist needs to know. Practical Neurology. 2019.http://dx.doi.org/10.1136/practneurol-2018-002081
Combined spinal-epidural versus epidural analgesia during labor: fetal effects and delivery outcomes-Dra. Thania Solar Del ValleRevista Médica SinergiaVol. 4 (6), Junio2019ISSN:2215-4523 / e-ISSN:2215-5279http://revistamedicasinergia.com13
5.Olawin A, Das J. Spinal Anesthesia. National Center for Biotechnology Information Search database [Internet]. 2019 [cited 19 January 2019]: NBK537299. Available from:https://www.ncbi.nlm.nih.gov/books/NBK537299/
6.Reynolds F. The effects of maternal labour analgesia on the fetus. Best Practice & Research Clinical Obstetrics & Gynaecology. 2010; 24(3): 289-302.https://doi.org/10.1016/j.bpobgyn.2009.11.003
7.Patel N, El-Wahab N, Fernando R, Wilson S, Robson S, Columb M et al. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia. 2014; 69(5): 458-467.https://doi.org/10.1111/anae.12602
8.Chau A, Tsen L. Update on Modalities and Techniques for Labor Epidural Analgesia and Anesthesia. Advances in Anesthesia. 2018; 36(1): 139-162.https://doi.org/10.1016/j.aan.2018.07.006
9.Michael R, Ervin M, Novak D. Obtetrics Normal and Problem Pregnancies. 7th ed. Philadelphia: Elsevier; c2017. Placental and Fetal Physiology: p. 28-29.
10.Abrão K, Francisco R, Miyadahira S, Cicarelli D, Zugaib M. Elevation of Uterine Basal Tone and Fetal Heart Rate Abnormalities After Labor Analgesia: A Randomized Controlled Trial. Obstetric Anesthesia Digest. 2009; 29(4): 207-208.https://doi.org/10.1097/AOG.0b013e31818f5eb6
11.Grant G. Adverse effects of neuraxial analgesia and anesthesia for obstetrics [Online]. Waltham, Massachusetts: UpToDate; 2019 [cited 22 January 2019]. Available from: https://www.uptodate.com/contents/adverse-effects-of-neuraxial-analgesia-and-anesthesia-for-obstetrics
12.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018 05 21;(5): CD000331.https://doi.org/10.1002/14651858.cd000331.pub4
13.Wang T, Sun S, Huang S. Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes. Anesthesia & Analgesia. 2017 05; 124(5): 1571-1580. https://doi.org/10.1213/ane.0000000000001709.
14.Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN,Lim Y, Chan ES, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews. 2014 Oct 09; (10): CD007238.https://doi.org/10.1002/14651858.cd007238.pub2
15.Ravindra G, Madamangalam A, Seetharamaiah S. Anaesthesia for non-obstetric surgery in obstetric patients. Indian Journal of Anaesthesia. 2018; 62(9): 710-716.https://doi.org/10.4103/ija.IJA_463_18
16.O’Sullivan O, Cockerham R. Spinal-induced hypotension at caesarean section. Anaesthesia & Intensive Care Medicine. 2016; 17(7): 328-330.https://doi.org/10.1016/j.mpaic.2016.04.003
17.Tan H, Sng B. Control of blood pressure during spinal anaesthesia for caesarean section. Trends in Anaesthesia and Critical Care. 2013; 3(3): 166-170.https://doi.org/10.1016/j.tacc.2013.02.010
2.Lowe N. The nature of labor pain. American Journal of Obstetrics and Gynecology. 2002; 186(5): S16-S24.https://doi.org/10.1016/S0002-9378(02)70179-8
3.Chu A, Ma S, Datta S. Analgesia in labour and delivery. Obstetrics, Gynaecology & Reproductive Medicine. 2017; 27(6): 184-190.https://doi.org/10.1016/j.ogrm.2017.04.001
4.O’Neal M. Obstetric anaesthesia: what a neurologist needs to know. Practical Neurology. 2019.http://dx.doi.org/10.1136/practneurol-2018-002081
Combined spinal-epidural versus epidural analgesia during labor: fetal effects and delivery outcomes-Dra. Thania Solar Del ValleRevista Médica SinergiaVol. 4 (6), Junio2019ISSN:2215-4523 / e-ISSN:2215-5279http://revistamedicasinergia.com13
5.Olawin A, Das J. Spinal Anesthesia. National Center for Biotechnology Information Search database [Internet]. 2019 [cited 19 January 2019]: NBK537299. Available from:https://www.ncbi.nlm.nih.gov/books/NBK537299/
6.Reynolds F. The effects of maternal labour analgesia on the fetus. Best Practice & Research Clinical Obstetrics & Gynaecology. 2010; 24(3): 289-302.https://doi.org/10.1016/j.bpobgyn.2009.11.003
7.Patel N, El-Wahab N, Fernando R, Wilson S, Robson S, Columb M et al. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia. 2014; 69(5): 458-467.https://doi.org/10.1111/anae.12602
8.Chau A, Tsen L. Update on Modalities and Techniques for Labor Epidural Analgesia and Anesthesia. Advances in Anesthesia. 2018; 36(1): 139-162.https://doi.org/10.1016/j.aan.2018.07.006
9.Michael R, Ervin M, Novak D. Obtetrics Normal and Problem Pregnancies. 7th ed. Philadelphia: Elsevier; c2017. Placental and Fetal Physiology: p. 28-29.
10.Abrão K, Francisco R, Miyadahira S, Cicarelli D, Zugaib M. Elevation of Uterine Basal Tone and Fetal Heart Rate Abnormalities After Labor Analgesia: A Randomized Controlled Trial. Obstetric Anesthesia Digest. 2009; 29(4): 207-208.https://doi.org/10.1097/AOG.0b013e31818f5eb6
11.Grant G. Adverse effects of neuraxial analgesia and anesthesia for obstetrics [Online]. Waltham, Massachusetts: UpToDate; 2019 [cited 22 January 2019]. Available from: https://www.uptodate.com/contents/adverse-effects-of-neuraxial-analgesia-and-anesthesia-for-obstetrics
12.Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018 05 21;(5): CD000331.https://doi.org/10.1002/14651858.cd000331.pub4
13.Wang T, Sun S, Huang S. Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes. Anesthesia & Analgesia. 2017 05; 124(5): 1571-1580. https://doi.org/10.1213/ane.0000000000001709.
14.Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN,Lim Y, Chan ES, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews. 2014 Oct 09; (10): CD007238.https://doi.org/10.1002/14651858.cd007238.pub2
15.Ravindra G, Madamangalam A, Seetharamaiah S. Anaesthesia for non-obstetric surgery in obstetric patients. Indian Journal of Anaesthesia. 2018; 62(9): 710-716.https://doi.org/10.4103/ija.IJA_463_18
16.O’Sullivan O, Cockerham R. Spinal-induced hypotension at caesarean section. Anaesthesia & Intensive Care Medicine. 2016; 17(7): 328-330.https://doi.org/10.1016/j.mpaic.2016.04.003
17.Tan H, Sng B. Control of blood pressure during spinal anaesthesia for caesarean section. Trends in Anaesthesia and Critical Care. 2013; 3(3): 166-170.https://doi.org/10.1016/j.tacc.2013.02.010
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