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Vol. 44. Núm. 12.
Páginas 544-551 (Enero 2001)
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Vol. 44. Núm. 12.
Páginas 544-551 (Enero 2001)
Acceso a texto completo
Analgesia epidural a demanda. Estudio de las consecuencias sobre el parto
On-patient-request epidural analgesia. A study about the consequences on childbirth
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5228
R. Moreno
Autor para correspondencia
musandizaga@hsd.es

Correspondencia: Hospital Son Dureta. Servicio de Obstetricia y Ginecología.Andrea Doria, 55. 07014 Palma de Mallorca
, M. González, V. Bonet, M. Usandizaga
Servicio de Obstetricia y Ginecología. Hospital Son Dureta.Palma de Mallorca
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Resumen
Objetivo

Estudiar el efecto de la introducción en un hospital del Insalud de la analgesia epidural a demanda

Material Y Métodos

Un total de 207 nulíparas con feto único a término que parieron en 1997, y 198 que lo hicieron en 1999-2000. Se comparan los dos grupos y, aisladamente, los partos con epidural de ambos grupos

Resultados

No hemos observado cambios en la frecuencia de partos operatorios o en la morbilidad neonatal, aunque se ha prolongado significativamente el parto con aumento del uso de oxitocina y de fiebre intraparto en el grupo más reciente. Las epidurales restringidas se asociaban a un parto más prolongado, más dosis de oxitocina y mayor empleo de fentanilo. Con la epidural a demanda hemos observado una prolongación del período expulsivo y una mayor frecuencia de mujeres que reciben oxitocina

Conclusiones

No hemos encontrado que la analgesia epidural se asocie a efectos adversos importantes sobre la evolución de los partos, lo que realza aún más los beneficios de esta técnica

Palabras clave:
Analgesia epidural
Cesárea
Parto instrumental
Oxitocina
Morbilidad neonatal
Abstract
Objective

To study the effect of on-patient-request epidural analgesia in a hospital of Insalud

Material And Method

207 nuliparas with unique fetus at term who gave birth in 1997 and 198 that did it in 1999–2000. Groups compare themselves both to each other and separately the childbirths with epidural analgesia of both groups

Results

We have not observed changes in the frequency of operative deliveries or on neonatal morbidity. There were differences in duration of labor, more use of oxytocin and maternal fever in the group of on-patient-request epidural analgesia. At the time of restricted use, the epidural analgesia was associated to prolonged labor, higher doses of oxytocin and greater use of fentanil. When using this analgesia on-request we have observed a prolongation of the second stage of labor and a greater number of women receiving oxytocin

Conclusions

We have not found the epidural analgesia is associated to important adverse effects on the evolution of childbirth, heightening the benefits of this technique

Keywords:
Epidural analgesia
Cesarean delivery
Instrumental delivery
Oxytocin
Neonatal morbidity
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Bibliografía
[1.]
D.J. Birnbach.
Analgesia for labor. Editorial.
N Eng J Med, 337 (1997), pp. 1764-1766
[2.]
C.J. Howell.
Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review).
The Cochrane Library, issue 3, Update Software, (1999),
[3.]
A. Miranda.
Tratado de anestesiología y reanimación en obstetricia: principios fundamentales y bases de aplicación práctica.
pp. 383-445
[4.]
D.S. Lyon, G. Knuckles, E. Whitaker, S. Salgado.
The effect of instituting an elective labor epidural program on the operative delivery rate.
Obstet Gynecol, 90 (1997), pp. 135-141
[5.]
L. Impey, K. MacQuillan, M. Robson.
Epidural analgesia need not increase operative delivery rates.
Am J Obstet Gynecol, 182 (2000), pp. 358-363
[6.]
Thorp JA. Analgesia epidural durante el trabajo de parto. Clin Obstet Ginecol 42: 713–728
[7.]
E. Lieberman, A. Cohen, J.M. Lang, R. D'Agostino, S. Datta, F.D. Frigoletto.
The association of epidural anesthesia with cesarean section in low risk women.
Obstet Ginecol, 88 (1996), pp. 993-1000
[8.]
J.A. Thorp, V.M. Parisi, P.C. Boylan, D.A. Johnston.
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women.
Am J Obstet Gynecol, 161 (1989), pp. 670-675
[9.]
J.A. Thorp, L.O. Eckert, M.S. Ang, D.A. Johnston.
Epidural analgesia and cesarean section for dystocia: Risk factors in nulliparas.
Am J Perinatol, 8 (1991), pp. 402-410
[10.]
J.A. Thorp, D.H. Hu, R.M. Albin, J. McNitt, B.A. Meyer, G.R. Cohen, J.D. Yeast.
The effect of intrapartum epidural analgesia on nulliparous labor: a randomized prospective trial.
Am J Obstet Gynecol, 169 (1993), pp. 851-858
[11.]
S.M. Ramin, D.R. Gambling, M.J. Lucas, S.K. Sharma, J.E. Sidawi, K.J. Leveno.
Randomized trial of epidural versus intravenous analgesia during labor.
Obstet Gynecol, 86 (1995), pp. 783-789
[12.]
A. Clark, D. Carr, G. Loyd, V. Cook, J. Spinnato.
The influence of epidural analgesia on cesarean delivery rates: a randomized, prospective clinical trial.
Am J Obstet Gynecol, 179 (1998), pp. 1527-1533
[13.]
B.A. Loughnan, F. Carli, M. Romney, C.J. Dore, H. Gordon.
Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour.
Br J Anaesth, 84 (2000), pp. 715-719
[14.]
T. Philipsen, N.H. Jensen.
Epidural block or parenteral pethidine as analgesic in labour; a randomized study concerning progress in labour and instrumental deliveries.
Eur J Obstet Gynecol Reprod Biol, 30 (1989), pp. 27-33
[15.]
S.K. Sharma, J.E. Sidawi, S.M. Ramin, M.J. Lucas, K.J. Leveno, F.G. Cunningham.
Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor.
Anesthesiology, 87 (1997), pp. 487-494
[16.]
H. Cammu, H. Verlaenen, J.J. Amy, K. De Koster, M.P. Derde, P. Buekens.
Epidural analgesia in active management of labor.
Acta Obstet Gynecol Scand, 73 (1994), pp. 235-239
[17.]
J. Zhang, M.A. Klebanoff, R. DerSimonian.
Epidural analgesia in association whit duration of labor and mode of delivery: A quantitative review.
Am J Obstet Gynecol, 180 (1999), pp. 970-977
[18.]
J.M. Shyken, J.S. Smeltzer, L.V. Baxi, K.J. Blakemore, S.E. Ambrose, R.H. Petrie.
A comparison of the effect of epidural general, and no anesthesia on funic acid-bases values by stage of labor and type of delivery.
Am J Obstet Gynecol, 163 (1990), pp. 802-807
[19.]
S.W. Roberts, K.J. Leveno, J.E. Sidawi, M.J. Lucas, M.A. Kelly.
Fetal acidemia associated whit regional anesthesia for elective cesarean delivery.
Obstet Gynecol, 85 (1995), pp. 79-83
[20.]
M.D. Mueller, H. Bruhwiler, G.K. Schupfer, et al.
Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery.
Obstet Gynecol, (1997), pp. 131-140
[21.]
R. Sherer, W. Holzgreve.
Influence of epidural analgesia on fetal and neonatal well-being.
Eur J Obstet Gynecol Reprod Biol, 59 (1995), pp. 31-33
[22.]
J.A. Bofill, R.D. Vincent, E.L. Ross, R.W. Martin, P.F. Norman, C.F. Werhan, et al.
Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia.
Am J Obstet Gynecol, 177 (1997), pp. 1465-1470
[23.]
L. Kapusta, E. Confino, B. Ismajovich, Y. Rosenblum, M.P. David.
The effect of epidural analgesia on maternal thermoregulation in labor.
Int J Gynaecol Obstet, 23 (1985), pp. 185-189
[24.]
E. Lieberman, J.M. Lang, F. Frigoletto, D.K. Richardson, S.A. Ringer, A. Cohen.
Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation.
Pediatrics, 99 (1997), pp. 415-419
[25.]
J.N. Robinson, E.R. Norwitz, A.P. Cohen, T.S. McElrath, E.S. Lieberman.
Epidural analgesia and third or fourth lacerations in nulliparas.
Obstet Gynecol, 94 (1999), pp. 259-262
[26.]
M.A. Fernández, J. Ros, A. Villalonga.
Fallos en la analgesia epidural obstétrica y sus causas.
Rev Esp Anestesiol Reanim, 47 (2000), pp. 256-265
[27.]
M. Nageotte, D. Larson, P. Rumney, M. Sidhu, K. Hollenbach.
A prospective randomized study of intrapartum epidural versus combination intrathecal epidural anesthesia with or witthout ambulation.
N Engl J Med, 337 (1997), pp. 1715-1719
[28.]
A. Olofsson, A. Ekblom, G. Ekman-Ordeberg, L. Irested.
Obstetric outcome following epidural analgesia with bupivacaineadrenaline 0.25% or bupivacaine 0.125% with sufentanil: a prospective randomized controlled study in 1000 parturients.
Acta Anaesthesiol Scand, 41 (1997), pp. 1-9
[29.]
D.H. Chestnut, J.M. McGrath, J.r. Vincent RD, D.H. Penning, W.W. Choi, J.N. Bates, et al.
Does early admistration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor?.
Anesthesiology, 80 (1994), pp. 1202-1208
[30.]
D.H. Chesnut, C.L. Owen, J.M. Bates, L.G. Ostman, W.W. Choi, M.W. Geiger.
Continuous infusion epidural analgesia during labor: a randomized double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine.
Anesthesiology, 68 (1988), pp. 754-759
[31.]
S.E. Cohen, B.S. Tan, G.A. Albright.
Epidural fentanyl-bupivacaine mixtures for obstetrics analgesia.
Anesthesiology, 67 (1987), pp. 403-407
[32.]
I. Amer-Whalin, M. Christoffersson, N. Dahlgren, H. Rydhstreom.
Epidural analgesia with sufentanil during labor and operative delivery.
Acta Obstet Gynecol Scand, 79 (2000), pp. 538-542
Copyright © 2001. Sociedad Española de Ginecología y Obstetricia
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