Labor pain is widely managed by epidural labor analgesia which is considered as a standard technique for managing labor.
Dexmedetomidine as a dose of 0.5 µg/mL
can be the optimal dose for parturient women in epidural labor analgesia when
combined with 0.1% Ropivacaine.
Labor
pain is widely managed by epidural labor analgesia which is considered as a
standard technique for managing labor. In this technique, Ropivacaine is
administered because of less motor block and stable hemodynamics. Dexmedetomidine, a α2-agonist for
α2-adrenergic receptors, exhibits both analgesic and sedative properties
without respiratory depressant effect. It can be added to local anesthetic
agents to increase the positive effect without increasing the incidence of side
effects. Dexmedetomidine has been successfully used in various experimental and
clinical studies for neuraxial block and epidural block with fewer side
effects. It has been approved for intravenous use only.
Rationale behind the research:
There is a lack of evidence regarding the use of
Dexmedetomidine in the obstetric population, and the optimal dose of epidural
Dexmedetomidine combined with Ropivacaine for labor analgesia is still
uncertain.
Objective:
To assess the
effect of Dexmedetomidine in combination with Ropivacaine during the labor
analgesia.
Outcome measures
The onset of epidural anesthesia, stages of labor, pain assessment using a visual analog scale (VAS), hemodynamic parameters, fetal heart rate, Apgar scores, level of sedation using Ramsay level of sedation scale and umbilical artery pH.
Time Points: Baseline and after 30 minutes
Study outcomes
Baseline: There were no statistically significant differences between the groups.
Figure 1: Comparison of analgesic efficacy between the groups.
It is known that Dexmedetomidine addition can lead to the increased potency of epidural Ropivacaine and further decreases the requirement of other analgesics. In this study, a comparative analysis was carried out between different doses of Dexmedetomidine in addition with Ropivacaine. The analysis concluded 0.5 µg/mL as the optimal dose of epidural Dexmedetomidine.
Dexmedetomidine addition to Ropivacaine increases the analgesic effects without increasing the incidences of side effects. Dexmedetomidine exhibits higher selectivity for the α2 receptor that is the potential cause for its effectiveness as a good analgesic and sedative. Fentanyl can lessen the concentration of epidural Ropivacaine and reduce the requirement of Ropivacaine for epidural labor analgesia. It was found that Dexmedetomidine causes less pruritus, less nausea and vomiting than Fentanyl during epidural labor analgesia. Thus, it can be safely used for epidural labor analgesia.
The results also
indicated that efficacy of 1 µg/mL of Dexmedetomidine was better than other
groups, but the side effects of this group were more. The motor block could
occur probably when 0.75 µg/mL or 1 µg/mL of Dexmedetomidine was used for
epidural labor analgesia. There were no significant differences observed in SpO2
and umbilical artery PaO2 between the groups during labor. There was
no incidence of respiratory depression observed despite good sedation with the
addition of Dexmedetomidine that leads to wide safety margins. Ramsay sedation
scores were measured to calculate analgesic effects between different groups,
and there was no occurrence of excessive sedation scores. In conclusion, it can
be inferred that 0.5 µg/mL of dexmedetomidine may be the optimal concentration
for epidural labor analgesia.
Several in vitro
studies have demonstrated that Dexmedetomidine has the potential to enhance the
frequency of uterine contractions, so there is further need of clinical
research in obstetric epidural anesthesia.
o 0.5 µg/mL of Dexmedetomidine can be used
in combination with 0.1% Ropivacaine in epidural labor analgesia for parturient
women.
Evidence-Based Complementary and Alternative Medicine, vol. 2017, Article ID 7924148, 4 pages, 2017
Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study
Zhang Wangping, Ren Ming
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