jurnal epidural fix terbaru
TRANSCRIPT
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Oleh :
Ferdi
Pembimbing :
Dr. H. Zulkifli, Sp.An, M.Kes
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Child birth is most paintful experiences a woman canunder go
This experience may have long-term andpsychological effects
The neuroaxial analgesia has surpassed
The current standart labor epidural analgesic regimensconsist
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IEB
compared CEI
PatientSatisfaction
ts
The need formanual
anesthesiaintervension
Laborprogessio
n
Modeof
delivery
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MEDLINE,
CENTRAL,EMBASE Original authors were
contact and asked forany clarification ofprimary outcomemeasures
Informationsources
and search
strategy
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Study Identification
All Publish RCTs comparing IEB and CEI
Healthy laboring women (nullipara & Para)
With lumbar epidural catheter placed
Primary outcome: patient satisfaction,anesthesia intervension & mode of delivery
Secondary: motor blockade, degree ofsensory blockade n side effect
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Data extract by 2 authors Data presented asmedians,range and CI, themean and standart deviationwere calculated AP < 0.1was consideredstatisically significantheterogenity I2 > 50 was considered toindicate significantheterogenity
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RESULTS
21 articles were selected for in depth fulltext article
9 articles were deemed eligible forinclusion
12 articles were exclude
344 subject received CEI
350 subject received IEB
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8 reported data on the mode ofdelivery
Studies included 652 subject
None of this studies reported asignificant difference in the CD rate
Mode of Delivery
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There was no statistically significant
different in total duration of labor
between IEB and CEI
the duration in second stage of labor
was statistically significantly shortened
in IEB group
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Sia et al., reported no significant difference in the
pain-free interval between CEI and IEB.
Wong et al., did report the time to first PCEAusage, and this was not significantly different
between the IEB and CEI groups.
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3 published data regarding the total dose of localanesthesia
5 studies reported the total dose given
There was a statically significant reduction in totallocal anesthesia with IEB
There was no publication bias for local anestheticconsumption
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4 studies reported with VRS with 0dissatisfied & 100 is extremely
satisfied
Wong et al reported satisfaction withVAS score
There was no publication bias formaternal satisfaction
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Subgroup Analysis of Primary Outcomes
Outcome base on 1. the use of CSE to initiatelabor analgesia 2. the use of PCEA duringmaintenance of labor analgesia
CSE did not have significant effect on any primaryoutcomes
PCEA
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Additiona
loutcomes
All Publish RCTs
comparing IEBand CEI
Healthylaboringwomen
(nullipara
& Para)
With lumbar epiduralcatheter placed
Primary outcome:patient satisfaction,
anesthesia intervension& mode of delivery
Secondary: motorblockade, degree of
sensory blockade n sideeffect
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Discussion
21
articleswereselectedfor indepthfull textarticle
9
articleswere
deemedeligible
forinclusion
12articleswereexclude
344subjectreceivedCEI
350subjectreceivedIEB
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9 high-quality low risk bias of RCTs
Evaluate IEB and CEI in labouring women
Mode ofmaintenance
Mode ofdelivery
Intermittent bolus
Reduced
local
consumption
Reduce
d
dose
No significant
effect
Reduce
d
Labour
time
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Studies
Small sample
Should be interpreted with caution
nstrument delivery
rate
Duration
of deliveryImprovement of
Maternal satisfactio
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IEB
Reduced local
anesthetic
consumption
Shorter secondstage of labour
Higher maternal
satisfaction
CEI
Higher dose
required
Longer first stage of
labour
Lower maternal
satisfaction
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