Publication: Vajinal doğum sonrası görülen bel ağrısının kombine spino-epidural analjeziye olan ilişkisi
Date
Authors
Authors
Kuyumcuoğlu, Çimen
Advisor
Şahin, Şükran
Language
Publisher:
Uludağ Üniversitesi
Journal Title
Journal ISSN
Volume Title
Abstract
Amaç: Bu çalışmada kliniğimizde doğum analjezisi amacıyla uyguladığımız kombine spino-epidural analjezi yönteminin, doğum sonrası bel ağrısı insidansı üzerine etkisini saptamayı amaçladık. Gereç ve Yöntem: Fakülte Etik Kurulu'nun onayı alındıktan sonra; çalışmaya vajinal yolla doğum yapması planlanan ve ASA I ve II grubuna giren, 198 olgu dahil edildi. Olgular analjezi isteklerine göre iki gruba ayrıldılar. İlk gruptaki olgulara kombine spino-epidural analjezi, oturur pozisyonda L3-4 veya L4-5 aralığından, hava ile direnç kaybı tekniği kullanılarak gerçekleştirildi (KSE grubu, n=104). ikinci gruptaki olgulara ise istekleri doğrultusunda herhangi bir analjezi yöntemi uygulanmayarak sadece doğum sonrası bel ağrısı açısından takip edildiler (non-epidural grup, 94 olgu). Doğum sonrası 24. saatte odalarında ziyaret edilen hastalarda bel ağrısı varlığı araştırıldı. Bel ağrısı yakınması olan hastalarda ağrının başlangıç zamanı (hamilelik öncesi, hamilelikte, doğumdan sonra), ağrının yeri, yayılımı, karakteri, beraberinde başka semptomların olup olmadığı sorularak kaydedildi. Doğumdan sonra 3. gün, 1. ay ve 6. ayda hastalar telefonla aranarak bel ağrısı aynı şekilde irdelendi ve doğumdan sonra yeni başlayan bel ağrısı açısından değerlendirildi. Bulgular: Tüm doğum sonrası bel ağrısı olan vakalar incelendiğinde doğum sonrası yeni başlayan bel ağrısı 60 olguda saptandı. Bunlardan 32'si (%53.3) kombine spino-epidural grupta ve 28'i (%46.6) non-epidural grupta olmak üzere gruplar arası anlamlı fark bulunmadı. Uzun dönemli takiplerinde de gruplar arasında bel ağrısı insidansında fark saptanmadı. Sonuç: Doğum analjezisinde sıklıkla uygulanan kombine spino-epidural bloğun doğum sonrası yeni gelişen bel ağrısı insidansını artırmadığını saptadık. Doğum öncesinde veya doğum sırasında bel ağrısı gelişen olgularda doğum sonrasında bel ağrısı görülme sıklığının uygulanan analjezi yönteminden bağımsız olarak yüksek olduğunu tespit ettik. Bu nedenlerle, doğum analjezisinde kombine spino-epidural bloğun bel ağrısı riskini artırmadan güvenle uygulanabileceği görüşündeyiz.
Aim: In this study, we aimed to determine the effects of combined spinal-epidural labor analgesia onto low-back pain incidence after vaginal delivery. Material and Methods: After faculty ethics committee approval, 198 (ASA I - II) patients included to the study. Patients were separated two groups regarding labor analgesia request. Combined spinal-epidural analgesia was performed in sitting position, from L3-4 or L4-5 interspinous processes with air to loss of resistance technique for first group (Group CSE, n=104). In second group no analgesic regimen was performed as patients request, we only follow-up these patients for low-back pain after vaginal delivery (non-epidural group, n= 94). The patients were visited after the first day of delivery in the hospital and asked for low-back pain. Patients complaining low-back pain were researched about the beginning time of low-back pain (before pregnancy, during pregnancy, after the delivery), where the pain is, if it's radiated, the character of the pain and other symptoms related to it. We contacted these patients by telephone on the third day, one month and sixth month after delivery and asked them if they had a new onset low-back pain. Results: We determined 60 new onset low-back pain after delivery in all. 32 (53.3%) of them were belonging to combined spinal-epidural group, and 28 (46.6%) of them were belonging to non-epidural group, without any significant differences between groups. We didn't establish any significant differences during long-time follow-ups between the groups. Conclusion: We determined that combined spinal-epidural analgesia for labor did not increase the new onset low-back pain incidence after delivery. Also, we established that low-back pain incidence was higher independently from the analgesia regimen, in patients with low-back pain before or during pregnancy. We concluded that, combined spinal-epidural analgesia could be performed safely without increasing the low-back pain incidence after delivery.
Aim: In this study, we aimed to determine the effects of combined spinal-epidural labor analgesia onto low-back pain incidence after vaginal delivery. Material and Methods: After faculty ethics committee approval, 198 (ASA I - II) patients included to the study. Patients were separated two groups regarding labor analgesia request. Combined spinal-epidural analgesia was performed in sitting position, from L3-4 or L4-5 interspinous processes with air to loss of resistance technique for first group (Group CSE, n=104). In second group no analgesic regimen was performed as patients request, we only follow-up these patients for low-back pain after vaginal delivery (non-epidural group, n= 94). The patients were visited after the first day of delivery in the hospital and asked for low-back pain. Patients complaining low-back pain were researched about the beginning time of low-back pain (before pregnancy, during pregnancy, after the delivery), where the pain is, if it's radiated, the character of the pain and other symptoms related to it. We contacted these patients by telephone on the third day, one month and sixth month after delivery and asked them if they had a new onset low-back pain. Results: We determined 60 new onset low-back pain after delivery in all. 32 (53.3%) of them were belonging to combined spinal-epidural group, and 28 (46.6%) of them were belonging to non-epidural group, without any significant differences between groups. We didn't establish any significant differences during long-time follow-ups between the groups. Conclusion: We determined that combined spinal-epidural analgesia for labor did not increase the new onset low-back pain incidence after delivery. Also, we established that low-back pain incidence was higher independently from the analgesia regimen, in patients with low-back pain before or during pregnancy. We concluded that, combined spinal-epidural analgesia could be performed safely without increasing the low-back pain incidence after delivery.
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Keywords
Doğum, Bel ağrısı, Kombine spino-epidural, Delivery, Low-back pain, Combined spinal-epidural
Citation
Kuyumcuoğlu, Ç. (2005). Vajinal doğum sonrası görülen bel ağrısının kombine spino-epidural analjeziye olan ilişkisi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.