Analgesia de parto

International Journal of Obstetric Anesthesia (2009) 18, 15–21 0959-289X/$ - see front matter c 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijoa.2008.01.020



ORIGINAL ARTICLE

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A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial
E. K. Junttila, P. K. Karjalainen, P. P.Ohtonen, T. H. Raudaskoski, P. O. Ranta
Departments of Anaesthesiology and Surgery, Obstetrics and Gynaecology, Oulu University Hospital, Finland

ABSTRACT Background: Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia. Methods: Multiparous womenin labour were randomised to receive either paracervical block or single-shot spinal analgesia. Pain was quantified using a numerical rating scale. Subsequent analgesia, progress of labour, and mode of delivery were noted. Fetal heart rate patterns were reviewed. Apgar scores and umbilical artery pH measurements were collected. Parturients’ satisfaction and willingness to have the same method oflabour analgesia again were recorded. Results: 122 parturients were randomised with data available on 104. Median pain scores decreased significantly in both groups; this was greater with single-shot spinal analgesia (difference between means 2.7; 95% CI 1.9-3.5; Pg < 0.001). Parturients receiving paracervical block received subsequent analgesia more often (23/56 vs. 3/48, P < 0.001). Progress oflabour, instrumental delivery rates, detected abnormal decelerations in cardiotocography and neonatal outcome were similar between groups. Shivering (P < 0.04) and pruritus (P < 0.001) were more common with single-shot spinal analgesia. Parturients in the paracervical block group were less satisfied (median 7.0, IQR 3.0–8.0 vs. median 9.0, IQR 8.0–10.0; P < 0.001) and less willing (28/55 vs. 39/48, P= 0.002) to have the same labour analgesia again. Conclusions: Paracervical block was less effective than single-shot spinal analgesia. Both methods were associated with a low incidence of fetal bradycardia but maternal side effects were more common with single-shot spinal analgesia. c 2008 Elsevier Ltd. All rights reserved.



Keywords: Labour pain; Paracervical block; Spinal analgesiaIntroduction
Epidural and spinal analgesia have been widely studied and accepted as the most effective methods of pain relief during labour and delivery.1,2 However, the techniques have some contraindications, and may not be available 24 h a day in every unit. Consequently other alternative effective methods of pain relief are necessary. Paracervical block (PCB) is an effective method of painrelief although adverse fetal effects, most notably bradycardia, have limited the use of this technique in many countries. However, when administered by lowdose superficial injection by an experienced obstetrician, PCB has been found to be safe.3–9 Conversely studies of spinal opioids have reported increased fetal bradycardia
Accepted January 2008 Correspondence to: Eija K. Junttila, MD, Department ofAnaesthesiology, Oulu University Hospital, PL 21, 90029 OYS, Finland. Tel.: +358(0)40 5693 919/+358(0)8 3152 705; fax: +358(0)8 3155 577. E-mail addresses: eija.junttila@ppshp.fi; eija_junttila@hotmail.com

rates, and the value of spinal analgesia with opioids has therefore been questioned.10 In Finland and in our delivery unit PCB and singleshot spinal (SSS) analgesia are widely used. Accordingto the Finnish perinatal statistics for 2004-2005, 43.3% of all parturients received epidural analgesia, 17.1% PCB and 12.0% SSS analgesia (http://www.stakes.fi/ FI/tilastot/aiheittain/Lisaantyminen/synnyttajat/index. htm). Combined spinal-epidural analgesia was used in only 0.2% of parturients. In 2004 in our unit 33.7% of parturients received epidural analgesia, 26.7% PCB and 15.8% SSS...