T. Manninen et al., A comparison of the hemodynamic effects of paracervical block and epiduralanesthesia for labor analgesia, ACT ANAE SC, 44(4), 2000, pp. 441-445
Citations number
17
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Background: Both paracervical block (PCB) and epidural analgesia are someti
mes associated with hemodynamic effects potentially harmful to the well-bei
ng of the fetus. Our study was designed to test the hypothesis that PCB wou
ld have a more profound effect on maternal and fetal blood flow than epidur
al analgesia.
Methods: Forty-four healthy primiparous parturients were randomized to rece
ive either PCB (n=21) or epidural analgesia (n=23) with 25 or 30 mg of bupi
vacaine, respectively for labor analgesia. Maternal blood pressure and feta
l heart rate were recorded. Blood flow was measured using a color Doppler d
evice. The blood flow measurements consisted of assessment of the pulsatili
ty indices (PI) of the right maternal femoral artery and the main branch of
the uterine artery (placental side), the umbilical artery and the fetal mi
ddle cerebral artery. The measurements were performed before administration
of analgesia and approximately 15-20 min later after the onset of analgesi
a.
Results: Both methods provided in general good analgesia, but rescue medica
tion was required more often after PCB. Epidural analgesia decreased matern
al blood pressure more than PCB and the PI of maternal femoral artery decre
ased after onset of epidural analgesia, indicating epidural-induced vasodil
ation. The PI of the uterine artery increased after the onset of PCB, indic
ating vasoconstriction of this artery. No significant adverse effects or di
fferences in the well-being of the newborn were observed, as indicated by s
imilar Apgar scores and pH-status.
Conclusion: There were small differences in the effects of PCB and epidural
analgesia on uteroplacental circulation as well as on maternal hemodynamic
s. PCB may have a vasoconstrictive effect on the uterine artery. This and t
he fact that the parturients required rescue analgesia more frequently afte
r PCB than after epidural block speaks for the feasibility of the latter in
obstetrics.
(C) Acta Anaesthesiologica Scandinavica 44 (2000).