RATIONALE FOR PARAVERTEBRAL BLOCK FOR ANALGESIA IN SPONTANEOUS LABOR

The article presents the comparative assessment of efficiency and safety of neuraxial pain relief in labor.

Subjects and methods. Four groups of 40 women in each group participated in the study: In Group 1, epidural analgesia was used for pain relief in labor, in Group 2, ultra-low-dose spinal analgesia was used, and paravertebral analgesia was used for pain relief in Group 3. And Control Group included 40 women with no pain relief in labor. The efficiency of analgesia in labor was monitored (scores by N.N. Rasstrigin and B.V. Shneider), as hemodynamic rates: heart rate, arterial tension, and median arterial tension (ATmed). Bromage scores were used for assessment of motor block. The changes in cervical dilatation and duration of the first and second period of the labor were assessed. All complications and negative effects of pain relief and impact of analgesia on the fetus were registered.

Results. All methods of pain relief demonstrated statistically significant reduction of sensitivity to pain. Dilating pains were evaluated as 7.15 scores in Group 1; 6.88 scores in Group 2, and 7.43 in Group 3. In Control Group it made 3.87 scores (p < 0.001). During the second period of labor epidural and paravertebral analgesia was the most effective: 6.78 scores in Group 1 and 6.20 scores in Group 3 (p < 0.05). After pain relief in Groups 1, 2 and 3 there was a statistically significant reduction of specific peripheral vascular resistance, ATmed, reduction of cardiac index due to normalization of heart rate. In the groups with pain relief, the time from the development of analgesic effect until full dilation was statistically significantly shorter. The best result was achieved through paravertebral analgesia (27.5 minutes faster versus Control Group, p < 0.001). The statistically significant increase of active pushing phase was observed in Group 2, on the average for 6.1 minutes longer versus Control Group (p < 0.005).

Conclusions. Neuraxial methods provide sufficient level of analgesia and are capable to manage labor abnormalities with no negative impact on the fetus. All represented methods of pain relief can be used for obstetric anesthesiology. In each specific obstetric situation, there is an option to choose the most appropriate method of pain relief.

epidural analgesia, ultra-low-dose spinal analgesia, paravertebral analgesia

1. Аntipin E.E., Uvarov D.N., Nedashkovskiy E.V. et al. Epidural analgesia in the first period of labor – it there an alternative? Anesteziologiya i Reanimatologiya, 2014, no. 1, pp. 18-22. (In Russ.)

2. Bunyatyan А.А., Mizikov V.M. Аnesteziologiya: natsionalnoe rukovodstvo. [Anaesthesiology. National Guidelines]. Moscow, GEOTAR-Media Publ., 2017, pp. 916-918.

3. Volkov Yu.N., Bolshov V.M., Singaevskiy S.B. et al. Metod. rekomen. MZ RSFSR. Kompleksnaya otsenka funktsional'nogo sostoyaniya sistem krovoobrashheniya i dykhaniya metodom integral'noj reografii tela: Metod. rekomen. MZ RSFSR. [Guidelines by RSFSR MoH. Integral assessment of blood circulation system and respiration function through integral body rheography]. 1989, 21 p.

4. Kulikov А.V., Shifman E.M. Pain relief in delivery. Clinical recommendations. Regionar. Anestesia i Lecheniye Ostroy Boli, 2013, vol. 7, no. 4, pp. 69-70. (In Russ.)

5. Polushin Yu.S., Аylamazyan E.K., Korostelev Yu.M. et al. Myth and reality of labor pain relief. J. Akush. I Zhen. Bolezn., 2011, no. 3, pp. 10-17. (In Russ.)

6. Pochyotny V.M., Kiselyov E.V. Experience of using minor concentrations of naropin for epidural analgesia in obstetrics. Zdravookhranenie Yugry: Opyt I Innovatsii, 2017, no. 3, pp. 25-26. (In Russ.)

7. Ryazanova O.V., Аleksandrovich Yu.S., Reznik V.А. et al. Pain relief in labor and post-natal depression. Is there any correlation? Journal Akusherstva i Zhenskikh Bolezney, 2017, vol. 66, no. 5, pp. 11-20. (In Russ.)

8. Shimanskaya O. Sh. Pain relief in spontaneous vaginal delivery using regional methods. Vestnik Khirurgii Kazakhstana, 2012, vol. 2b, no. 30, pp. 81-83. (In Russ.)

9. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 295: pain relief during labor. Obstet. Gynecol., 2004, no. 2, pp. 104-213.

10. Anim-Somuah M., Smyth R., Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst. Rev., 2005, vol. 19, no. 4, CD000331.

11. Aziato L., Acheampong A.K., Umoar K.L. Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana. BMC Pregnancy and Childbirth, 2017, vol. 17, pp. 73.

12. Dirkje C.Z., Mechthild M.G., Susanne G.B. et al. The dynamics of epidural and opioid analgesia during labour. Archives of Gynecology and Obstetrics, 2016, vol. 294, no. 5, pp. 967.

13. Goetzl L.M. ACOG Committee on practice bulletins-obstetrics. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Obstet. Gynecol., 2002, no. 1, pp. 177-191.

14. Howell C.J. Epidural versus non-epidural analgesia for pain relief in labour. Cochrane Database Syst. Rev., 2005, vol. 4, CD000331.

15. Klomp T., van Poppel M., Jones L. et al. Inhaled analgesia for pain management in labour. Cochrane Database of Systematic Reviews, 2012, is. 9, Arth. No.: CD009351. DOI: 10.1002/14651858.CD009351.pub2

16. Maltau J.M., Eielsen O.V., Stokke K.T. Effect of stress during labor on the concentration of cortisol and estriol in maternal plasma. Am. J. Obstet. Gynecol., 1979, vol. 15, no. 6, pp. 681-684.

17. Paech M. Newer techniques of labor analgesia. Anesthesiology Clinics of North America, 2003, vol. 21, no. 1, pp. 1-17.

18. Richardson M.G., Lopez B.M., Baysinger C.L. et al. Nitrous oxide during labor: maternal satisfaction does not depend exclusively on analgesic effectiveness. Anesth. Analg., 2017, vol. 124, no. 2, pp. 548–553. doi: 10.1213/ANE.0000000000001680

19. Richardson J., Jones J., Atcinson R. The effect of thoracic paravertebral blockade on somato-sensory voked potentials. Anesth. Analg., 1998, vol. 87, pp. 373.