Doğum eylemindeki gebelerde analjezik olarak intravenöz parasetamol kullanımının etkinliği
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Date
2009
Authors
Aydın, Gerçek
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Doğum ağrısının giderilmesi ya da azaltılmasında intravenöz parasetamolün etkinliğinin araştırılmasıdır.Çalışmamız prospektif, plasebo kontrollü, iki merkezli olarak dizayn edildi. Çalışmaya dahil edilen 93 gebe, epidural analjezi (n=24), parenteral parasetamol (n=32) ve plasebo (n=37) olarak üç gruba ayrıldı. Ağrı skorlaması 30 dakikada bir Visual Analog Scale (VAS) kullanılarak yapıldı. Gruplar arası İstatistiksel analiz Kruskal-Wallis testi, İkili değerlendirmeler non-parametrik Mann-Whitney U testi, değişkenler arasındaki ilişki Pearson korelasyon katsayısı ve Spearman's rho korelasyon katsayısı kullanılarak yapıldı. p<0,05 anlamlı kabul edildi.Gruplar arasında VAS ortalamaları bakımından anlamlı fark saptandı (p<0,001). Epidural analjezi grubu, parasetamol grubu (p<0,001) ve plasebo grubu (p<0.001) ile karşılaştırıldığında epidural analjezi lehine anlamlı fark tespit edildi. Parasetamol grubu plasebo grubu ile karşılaştırıldığında parasetamol grubu lehine anlamlı fark tespit edildi (p<0.001). VAS skoru ortalamaları epidural, intravenöz parasetamol ve plasebo grupları için sırasıyla 4,67±1,33 , 7,23±1,28 ve 8,55±0,52 idi. Travay süresi bakımından anlamlı fark saptanmadı. Fetal ağırlığın travay süresi ve ağrı skorları üzerine anlamlı etkisi olmadığı belirlendi. Yenidoğan Apgar skorlarına bakıldığında 1. dakika (dk) için en yüksek ortalama plasebo grubunda (8,37±1,70), en düşük ortalama ise epidural analjezi grubunda (7,50±1,61) idi. 5. dk Apgar skorları açısından gruplar arasında fark saptanmadı.Epidural analjezinin uygulanamadığı durumlarda intravenöz parasetamol güvenli ve kolay uygulanabilir bir seçenek olarak göz önünde bulundurulabilir. İntravenöz parasetamolün tek başına ya da kombinasyon tedavilerinde daha sık ya da farklı dozlar kullanılarak etkinliğinin değerlendirileceği, iyi standardize edilmiş geniş katılımlı klinik çalışmalara ihtiyaç duyulmaktadır.
To investigate the effectiveness of intravenous paracetamol for eliminating or decreasing labor pain.This study is designed as a prospective, placebo controlled, two-centered study. Totally 93 pregnant women included in the study, were randomized to three groups as epidural analgesia (n=24), intravenous paracetamol (n=32) and placebo (n=37). Pain scoring is done by using Visual Analog Scale (VAS) for every 30 minutes. Kruskall-Wallis test is used for statistical analysis of groups. Any two groups were compared with non-parametric Mann-Whitney U test and relations for variables were studied with Pearson correlation coefficient and Spearman?s rho correlation coefficient. p<0,05 was accepted as significant.Significant difference was detected for mean VAS scores between groups (p<0,01). Significant difference was detected in favor of epidural analgesia group when compared to paracetamol group (p<0,001) and placebo group (p<0.001). Significant difference was detected in favor of paracetamol group when compared to placebo group (p<0.001). Mean VAS scores were 4,67±1,33, 7,23±1,28 and 8,55±0,52 for epidural, intavenous paracetamol and placebo groups, respectively. No significant effect of fetal weight over duration of labor and pain scores was observed. When the Apgar scores are compared, the highest value was in placebo group (8,37±1,70), while the lowest was in epidural analgsia group (7,50±1,61) for the 1st minute scores. There was no difference between groups, regarding the 5th minute Apgar scores.Intravenous paracetamol may be considered as a safe and feasible option in cases when epidural analgesia can not be performed. Further investigations, with larger and well standardized groups, studying the effectiveness of more frequent or different doses of intravenous paracetamol as a single or a part of combined treatment for labor pain, are needed.
To investigate the effectiveness of intravenous paracetamol for eliminating or decreasing labor pain.This study is designed as a prospective, placebo controlled, two-centered study. Totally 93 pregnant women included in the study, were randomized to three groups as epidural analgesia (n=24), intravenous paracetamol (n=32) and placebo (n=37). Pain scoring is done by using Visual Analog Scale (VAS) for every 30 minutes. Kruskall-Wallis test is used for statistical analysis of groups. Any two groups were compared with non-parametric Mann-Whitney U test and relations for variables were studied with Pearson correlation coefficient and Spearman?s rho correlation coefficient. p<0,05 was accepted as significant.Significant difference was detected for mean VAS scores between groups (p<0,01). Significant difference was detected in favor of epidural analgesia group when compared to paracetamol group (p<0,001) and placebo group (p<0.001). Significant difference was detected in favor of paracetamol group when compared to placebo group (p<0.001). Mean VAS scores were 4,67±1,33, 7,23±1,28 and 8,55±0,52 for epidural, intavenous paracetamol and placebo groups, respectively. No significant effect of fetal weight over duration of labor and pain scores was observed. When the Apgar scores are compared, the highest value was in placebo group (8,37±1,70), while the lowest was in epidural analgsia group (7,50±1,61) for the 1st minute scores. There was no difference between groups, regarding the 5th minute Apgar scores.Intravenous paracetamol may be considered as a safe and feasible option in cases when epidural analgesia can not be performed. Further investigations, with larger and well standardized groups, studying the effectiveness of more frequent or different doses of intravenous paracetamol as a single or a part of combined treatment for labor pain, are needed.
Description
Keywords
İntravenöz parasetamol, Doğum ağrısı, VAS, Intravenous paracetamol, Labor pain
Citation
Aydın, G. (2009). Doğum eylemindeki gebelerde analjezik olarak intravenöz parasetamol kullanımının etkinliği. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.