labor analgesia: which technique do you choose?
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Post on 16-Jul-2015
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Dr. I Gede Budiarta, Sp.An KMNBAG / SMF ANESTESI DAN TERAPI INTENSIF
RS SANGLAH – FK UNUD BALI
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“Labor results in severe pain for many women. There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care… Maternal request is a sufficient medical indication for pain relief during labor.”
ACOG & ASA
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FIRST STAGE : TH 10 – L1 2ND STAGE : S2-S4
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Pain at the first stage
Pain at the end of first stage and the beginning of second stage
Pain at the end of second stage
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Takut CemasIgnorance
TakipneuKonsumsi O2
CO2↓
Katekolamin kortisol
Kontraksi Uterus ↓
Perfusi Plasenta ↓
Stimulasisimpatis
Tek.darah Curah jantung
Resistensi vascular
Pengosongan lambung lambat
Asam Laktat Free Fatty Acid
Asidosis Metabolik
Fetal AcidemiaFetal Hipoxia
NYERI
GAWAT JANIN
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IntervensiNon Farmakologi
IntervensiFarmakologi
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1. Hypnosis2. Biofeedback3. Intracutaneus / subcutaneus sterile
water injection4. Water birth5. Aromatherapy6. Teknik relaksasi ( Yoga, music, audio )7. Acupuncture atau acupresurre8. Massage / reflexology9. TENS
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1. Inhaled Analgesia2. Opioids3. Non opioids drugs4. Local anesthetics nerve blocks5. Epidural dan CSE
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1. Insufficient Evidence to Make a Judgement
2. What May Work
3. What Works
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Tidak ada bukti perbedaan bermakna pada teknik berikut dibandingkan standar care atau
tanpa intervensi
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TERDAPAT BUKTI BAHWA TEKNIK BERIKUT
LEBIH BAIK DIBANDINGKAN PLACEBO ATAU
STANDAR CARE, AKAN TETAPI BUKTI MASIH
TERBATAS PADA PENELITIAN INDIVIDUAL /
RCT DAN TIDAK KONSISTEN. BEBERAPA PENELITIAN LAIN MENYATAKAN
TIDAK ADA PERBEDAAN BERMAKNA.
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TERDAPAT CUKUP BUKTI YANG
MENYATAKAN KEGUNAAN DAN
PERBEDAAN BERMAKNA
PENGGUNAAN TEKNIK BERIKUT UNTUK
MENGURANGI NYERI PERSALINAN,
AKAN TETAPI TETAP ADA RESIKO EFEK
SAMPING
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Apakah perbedaan beberapa menit lebih menguntungkan dibandingkan biaya extra
memakai CSE??
Apakah Rapid Onset CSE menguntungkan secara klinis sehari-
hari???
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Untuk teknik intermitten bolus epidural, lebih baik menggunakan teknik PIEB (Programmed
Intermitten Epidural Bolus) dibandingkan teknik traditional / konvensional
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Total dosis bupivacaine lebih rendah dengan teknik PIEB dibandingkan epidural kontinyu.
Breakthrough pain lebih rendah pada PIEB dan tingkat kepuasan pasien lebih tinggi dengan
teknik PIEB.
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PCEA memerlukan total dosis bupivacaine lebih rendah, blok motorik & intervensi anestesi lebih jarang dibandingkan infus
kontinyu epidural
PCEA ( Patient Controled Epidural Analgesia ) vs Infus Kontinyu Epidural?
Rekomendasi : digunakan Ropivacaine 0,1% + Fentanyl 2 mcg/ml dengan PCEA mode background infus kontinyu 5 ml/jam + demand dose 5 ml, LOI 12 mnt. Max dosis 20 ml/jam
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American Society of Anesthesiologists © 2007 – Standards, Guidelines and Statements
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American Society of Anesthesiologists © 2007 – Standards, Guidelines and Statements
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DEPENDS ON YOUR :1.KNOWLEDGE2.SKILL3.EXPERIENCE
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