Prolonged epidural analgesia as a component of treatment for uterine inertia
DOI:
https://doi.org/10.15574/HW.2025.5(180).2730Keywords:
prolonged epidural analgesia, uterine inertia, pathological preliminary period, fentanyl, bupivacaine, autonomic nervous systemAbstract
The effectiveness of treating labor weakness largely depends on anesthetic care, as modern obstetric care requires mandatory pain relief during labor, regardless of its nature. The search for an optimal method of labor pain relief remains relevant due to the risk of developing or exacerbating uterine inertia when using traditional epidural analgesia techniques.
Aim - to improve the effectiveness of anesthetic management in women with existing uterine inertia to ensure successful vaginal delivery.
Materials and methods. An analysis of 60 labor cases was conducted. The parturients were divided into two groups: Group I (study group, n=35) — delayed administration of local anesthetic (analgesia initiated with 50 mcg of fentanyl, while bupivacaine (0.125-0.25%) was administered only on demand after 1-1.5 hours); Group II (control group, n=25) — standard technique (simultaneous administration of bupivacaine (0.125-0.25%) and 50 mcg of fentanyl for analgesia initiation). The effectiveness of analgesia was assessed using the visual analog scale, maternal hemodynamic parameters, and the mode of delivery. Fetal status was monitored via cardiotocography.
Results. In the study group, the rate of physiological deliveries was 69%. The use of a pure opioid at the initial stage allowed for the relief of "sympathetic stress" and normalization of the autonomic nervous system function, which facilitated the effective action of oxytocin. In the control group, only 18% of women had a vaginal delivery, while 72% required an emergency cesarean section due to ineffective labor activity and fetal distress.
Conclusions. Starting neuraxial analgesia with opioids without a local anesthetic is pathogenetically justified in cases of uterine inertia. It allows for breaking the "pain-stress-oxytocin inhibition" cycle without creating a premature motor block, significantly reducing the rate of operative delivery.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. Informed consent was obtained from all participating women.
The authors declare no conflict of interest.
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