Özet:

Objective: Our aim was to compare the clinical efficacies of combined spinal-epidural analgesia and epidural analgesia techniques performed with the continuous patient controlled infusion method in labor analgesia. Material and Methods: Following approval of the local ethics committee, 60 primigravid singleton pregnant women between 36 and 42 weeks of pregnancy, with vertex presentation and planned to give vaginal birth were included in the study. Patients were randomly divided into two groups. (Group 1: Combined spinal epidural analgesia (CSE) group and Group 2: Epidural analgesia (EP) group). Participants in CSE group were given a total volume of 1 ml, which is composed of 2.5 mg hyperbaric bupivacain and 25 µg fentanyl. EP infusion solutions were prepared with bupivacaine (0.5 mg/ml) and fentanyl (1.5µg/ml) for use in both groups. The degree of pain was assessed by using visual analogue scale (VAS).A10 ml loading dose consisting of 0.125% bupivacaine and 50 µg fentanyl was applied in the EP group. The CSE group received this dose when the VAS score reached 4 after the disapearance of the effect of intrathecal dose. EP infusions with a basal flow rate of 10ml/hr were given immediately after bolus doses. The pregnant women in both groups were able to apply themselves a bolus dose of 10 ml when needed. Maternal and fetal hemodynamic parameters were monitored. The period of time from the first application of analgesia until total dissappearance of the pain was recorded in all subjects. The durations of the first and second stages of labor, durations of EP infusions, total amounts of EP infusions, consumed bupivacaine amounts, any need for further bolus doses, adverse effects in the intrapartum and postpartum periods were recorded. Results: Initiation time of analgesia in subjects of CSE group was much shorter than the EP group. Especially, more rapid dilatation of cervix in the first stage of labor and a shorter labor time were observed in CSE group. Better preserved maternal hemodynamics without hypotension, lower amounts of infused local anesthetics and better patient satisfaction were also observed in theCSEgroup compared with the EPgroup. Conclusion: We can comment that CSE analgesia technique performed with continuous patient controlled infusion method is a more reliable method than EPanalgesia technique in labor analgesia.

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