Comparative evaluation of epidural bupivacaine – dexmedetomidine and bupivacaine – fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor

Selim, Mohamed Fouad and Ali Elnabtity, Ali Mohamed and Ali Hasan, Ali Mohamed (2012) Comparative evaluation of epidural bupivacaine – dexmedetomidine and bupivacaine – fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor. Journal of prenatal medicine, 6 (3). pp. 47-54. ISSN 1971-3290

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Abstract

Objective: uteroplacental blood flow is affected by myometrial contractions and hypotension. Epidural analgesia is frequently complicated by hypotension. The aim of the study was to compare the effect of bupivacaine- dexmedetomidine (BD) or bupivacaine – fentanyl (BF) on uterine artery pulsatitly index (UtAPI) and umbilical artery pulsatitly index (UA-PI) during uterine contractions and relaxations. Methods: this was a prospective controlled observational study performed in 130 healthy full term parturients divided into 3 groups [23 cases as control, 44 cases as (BD) epidural group and 43 cases as (BF) epidural group]. Over the study duration of 120 minutes; UtA-PI and UA-PI were measured at baseline, 30, 60, 120 minutes during uterine contractions and relaxations. Maternal hemodynamic, visual analogue scale (VAS), sedation score, side effects of epidural analgesia including nausea, vomiting, pruritis and respiratory depression were assessed. Results: VAS significantly decreased after epidural compared with control group. BD group showed significant improvement in onset and duration of analgesia and sedation scores with lower incidence of nausea and pruritis compared with BF group. The BF and BD groups were associated with significant maternal hypotension and bradycadia that increase the UtA-PI during uterine contractions and relaxations compared with control group. UA-PI was increased with uterine contractions compared with during uterine relaxations in the three studied groups yet the effect of epidural and uterine contractions does significantly affect newborns apgar scores or umbilical cord pH. Conclusion: bupivacaine- dexmedetomidine epidural analgesia showed better maternal satisfaction for labor pains control compared with bupivacaine – fentanyl without deleterious effect on utroplacental circulation and newborns outcome.

Item Type:	Article
Uncontrolled Keywords:	Epidural analgesia, dexmedetomidine, fentanyl, Doppler ultrasound, uterine artery, umbilical artery
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 618 Altri rami della medicina; Ginecologia e ostetricia, Pediatria, Geriatria > 618.2 Ostetricia
Depositing User:	Gianni Aiello
Date Deposited:	29 May 2013 11:59
Last Modified:	29 May 2013 11:59
URI:	http://eprints.bice.rm.cnr.it/id/eprint/5394

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