Abstract
Purpose
To determine the effect of epidural analgesia on biochemical markers of stress, plasma oxytocin concentrations and frequency of uterine contractions during the first stage of labour.
Methods
Nine nulliparous women, in spontaneous labour, with a singleton fetus and cervical dilatation ≤ 5 cm were enrolled. Epidural bupivacaine 0.25% (range 10 – 14 ml) was administered and bilateral sensory blockade to ice (T8 – L4) achieved. Blood samples were collected before the epidermal block and every 10 min for one hour after the block was achieved for the measurement of plasma beta-endorphin, cortical, glucose, lactate and oxytocin concentrations. No exogenous oxytocin was given. Intensity of pain was assessed at the time of the blood sampling using a 10 cm visual analogue scale (VAS). The frequency of uterine contractions was recorded for 60 min before and after the epidural block.
Results
There was a decrease in plasma beta-endorphin and cortisol concentrations after epidural block (P < 0.01). There were no changes in plasma glucose and lactate concentrations. The mean VAS for pain decreased 10 min after epidural block was achieved and remained < 2 throughout the study period (P < 0.001). Mean plasma oxytocin concentrations did not change. The frequency of uterine contractions before and after the epidural block was similar.
Conclusions
The metabolic stress response to the pain of labour was attenuated by epidural analgesia. In contrast, plasma oxytocin concentration and frequency of uterine contractions were unaffected by the attenuation of metabolic stress response.
Résumé
Objectif
Déterminer l’effet de l’analgésie péridurale sur les marqueurs biochimiques de stress, les concentrations plasmatiques d’oxytocine et la fréquence des contractions utérines pendant le premier stade du travail.
Méthode
Neuf femmes nullipares, en travail spontané, porteuse d’un seul fœtus et présentant une dilatation du col de l’utérus <- 5 cm, ont été recrutées. On a administré de la bupivacaïne péridurale à 0,25 % (de 10 à 14 ml) et on a procédé à un blocage sensoriel bilatéral à la glace (T8 – L4). On a prélevé des échantillons de sang avant le point dermique et à toutes les 10 minutes pendant une heure après le bloc afin de mesurer les concentrations plasmatiques de ß-endorphine, de cortisol, de glucose, de lactate et d’oxytocine. On n’a pas administré d’oxytocine exogène. L’intensité de la douleur a été évaluée au moment des prélèvements sanguins en utilisant une échelle visuelle analogique (EVA) de 10 cm. La fréquence des contractions utérines a été enregistrée pendant 60 minutes avant et après l’analgésie péridurale.
Résultats
On a observé une baisse de la ß-endorphine plasmatique et des concentrations de cortisol après l’analgésie péridurale (P < 0,01). Il n’y a pas eu de changements dans les concentrations de glucose et de lactate. La moyenne de l’EVA pour la douleur a diminué, 10 minutes après le bloc péridural et est demeurée < 2 pendant toute la durée de l’étude (P < 0,001). Les concentrations moyennes d’oxytocine n’ont pas changé. La fréquence des contractions utérines avant et après l’analgésie péridurale était similaire.
Conclusion
La réaction métabolique d’alarme liée aux douleurs de l’accouchement a été atténuée par l’analgésie péridurale. Par ailleurs, les concentrations plasmatiques d’oxytocine et la fréquence des contractions utérines n’ont pas été affectées par l’atténuation de la réaction métabolique.
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Supported by the McGill and Royal Victoria Hospital Departments of Anesthesia.
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Scull, T.J., Hemmings, G.T., Carli, F. et al. Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged. Can J Anaesth 45, 626–630 (1998). https://doi.org/10.1007/BF03012090
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DOI: https://doi.org/10.1007/BF03012090