Abstract
Purpose
Lumbar epidural analgesia (LEA) decreases maternal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephnne (Epi) and norepinephnine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA.
Methods
Twenty-four healthy women in active labour received either 25 μ/g ITF (n = 12) or epidural lidocaine 1.5% (n = 12) for analgesia. Venous blood samples were collected before anaesthesia and at five minute intervals for 30 mm following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores (VAS) to pain and pruntus were recorded at the same time.
Results
Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyi(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01).
Conclusion
We conclude that ITF is as effective as LEA in producing pain relief in the labounng patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epmephnne concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamme during labour.
Résumé
Objectif
L’analgésie épidurale lombaire (AÉL) diminue le stress maternel déterminé par le dosage des concentrations plasmatiques de catécholamines. Le fentanyl sous-arachnoïdien (FSA) procure une analgésie efficace pendant le travail mais on ne connaît pas son influence sur les concentrations maternelles d’épinéphnne (ÉPI) et de norépinéphnne (NÉ). Cette étude visait à déterminer si le FSA diminuait le stress de la même façon que l’AÉL.
Méthodes
Vingt-quatre partunentes bien portantes en travail ont reçu pour l’analgésie soit du FSA 25 μg (n = 12) soit de la lidocaïne épidurale 1,5% (n = 12). Des échantillons de sang veineux ont été recueillis avant l’anesthésie et à des intervalles de cinq minutes pendant 30 min après l’anesthésie dans le but de mesurer l’ÉPI et la NF plasmatiques par Chromatographie en phase liquide à haute performance. En même temps, la pression artérielle (PA). la fréquence cardiaque et les scores d’une échelle visuelle analogique (ÉVA) pour la douleur et le prurit étaient enregistrés.
Résultats
Le FSA et l’AÉL diminuent les scores d’ÉVA, la PA et les concentrations d’ÉPI avec des effets minimes sur les concentrations plasmatiques de NÉ. Le FSA et l’AÉL réduisent également l’ÉPI plasmatique. mais la réduction est un peu plus rapide avec le FSA. Le FSA et l’AÉL diminuent respectivement les concentrations de 51% et 52% (P < 0,01).
Conclusion
Le FSA est aussi efficace que l’AÉL pour soulager la douleur chez la partunente en travail. Le fentanyl sous-arachnoïdien diminue aussi les concentrations maternelles d’épinéphnne. protégeant ainsi la partunente en travail des effets nocifs de concentrations excessives de catécholamines.
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Cascio, M., Pygon, B., Bernett, C. et al. Labour analgesia with intrathecal fentanyl decreases maternal stress. Can J Anaesth 44, 605–609 (1997). https://doi.org/10.1007/BF03015443
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DOI: https://doi.org/10.1007/BF03015443