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La analgesia epidural no retrasa el trabajo de parto
OBJECTIVE: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control.
METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.08% ropivacaine with 0.4 micrograms/mL sufentanil with patient-controlled epidural analgesia. At the onset of the second stage of labor, women were randomized to receive a blinded infusion of the same solution or placebo saline infusion. The primary outcome was the duration of the second stage of labor. A sample size of 200 per group (400 total) was planned to identify at least a 15% difference in duration.
RESULTS: Between March 2015 and September 2015, 560 patients were screened and 400 patients (200 in each group) completed the study. Using an intention-to-treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52). The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17). Pain scores were similar between groups at each measurement during the second stage. More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001).
CONCLUSION: Maintaining the infusion of epidural medication had no effect on the duration of the second stage of labor compared with a placebo infusion. Maternal and neonatal outcomes were similar. A low concentration of epidural local anesthetic does not affect the duration of the second stage of labor.
CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Register, http://www.chictr.org.cn/enindex.aspx, ChiCTR-IOR-15005875.
Corresponding author: Philip E. Hess, MD, YA-204B East Campus, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; email: phess@bidmc.harvard.edu.
© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Desde los años 70 se introduce la analgesia en el espacio epidural de la médula para aliviar de forma eficaz el dolor producido por el parto.
Casi desde el inicio de la práctica habitual de la analgesia en el parto se ha admitido que retrasa la segunda fase del parto, es decir, el descenso de la cabeza del bebe una vez está alcanzada la dilatación completa.
Algunos obstetras tienen por costumbre reducir la canditad de anestesico en el descenso del feto para que la paciente empuje mejor. Esto supone, con seguridad, un aumento de la desagradable sensación de dolor.
Pues bien, una de las mas prestigiosas revistas de ginecologia ha publicado un estudio serio, con 400 mujeres, que compara el tipo de parto en aquellas mujeres a las que se les suministra analgesia en esta fase del parto y a las que no.
Los resultados dicen que no hay diferencias ni en la incidencia de episiotomías, ni en la posición del feto, ni en ninguno de los marcadores de bienestar fetal
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Torrijo
