Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.022
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of standing stability with different doses in epidural fentanyl among post-cesarean delivery women: a prospective trial

Comparação da estabilidade em pé com diferentes doses de fentanil peridural em mulheres pós-cesáreas: um estudo prospectivo

Masayuki Oshima; Kazuyoshi Aoyama

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Abstract

Background
The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery.

Methods
A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL-1 (Group 1, n = 8) or 5 mcg.mL-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups.

Results
Participants’ demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm2, p < 0.05).

Conclusions
Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL-1 at 5 mL.h-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.

Keywords

Cesarean section;  Analgesia;  Epidural;  Standing position;  Postural balance;  Early ambulation

Resumo

Justificativa: O objetivo do estudo foi determinar a segurança e eficácia de diferentes doses de fentanil peridural mais anestésicos locais na deambulação de pacientes que tiveram cesariana eletiva. Métodos: Um estudo prospectivo em um único hospital comunitário usou a posturografia para calcular a área de Sway para avaliação da estabilidade em pé [ISRCTN14517337]. A infusão peridural contínua de ropivacaína a 0,2% contendo 2,5 mcg/ml-1 (Grupo 1, n = 8) ou 5 mcg/ ml-1 de fentanil (Grupo 2, n = 8) foi aleatoriamente designada a um indivíduo e iniciada a uma taxa de 5 ml/ h-1 no pós-operatório e continuou por 48 horas após a cesariana, além de paracetamol e ibuprofeno em pé. A posturografia medida com SYMPACKTM foi usada para calcular a área de Sway para investigação da estabilidade em pé. O teste t não pareado foi utilizado para comparar variáveis contínuas entre os grupos. A análise de variância (ANOVA) foi usada para avaliar as diferenças da área de Sway medida repetidamente dentro dos grupos. Resultados: A demografia das participantes, o status da dor e a função motora da perna um dia após a cesariana não foram diferentes entre os grupos. A área de oscilação no Grupo 1 não foi diferente em três medidas repetidas. A área de oscilação do Grupo 2 no 1º dia de pós-operatório, com analgesia peridural, foi significativamente maior do que na linha de base (4,1±2,8 vs. 3,1±1,1 cm2 , p < 0,05). Conclusões: Como as concentrações baixas e altas de fentanil peridural permitiram que os participantes deambulassem com o mesmo efeito de dor, a concentração mais baixa de fentanil peridural contínuo (2,5 mcg/ml-1 a 5 ml/h-1) é necessária para evitar possíveis eventos adversos durante a deambulação após cesariana.

Palavras-chave

Cesariana; Analgesia; Epidural; Posição de pé; Equilíbrio postural; Deambulação precoce

References

1 D. Buggy, N. Hughes, J. Gardiner Posterior column sensory impairment during ambulatory extradural analgesia in labour Br J Anaesth, 73 (1994), pp. 540-542

2 M.G. Parry, R. Fernando, G.P. Bawa, et al. Dorsal column function after epidural and spinal blockade: implications for the safety of walking following low-dose regional analgesia for labour Anaesthesia, 53 (1998), pp. 382-387

3 T.W. Breen, T. Shapiro, B. Glass, et al. Epidural anesthesia for labor in an ambulatory patient Anesth Analg, 77 (1993), pp. 919-924

4 L. Hauk American Academy of Family Physicians. Planning for Labor and Vaginal Birth After Cesarean Delivery: Guidelines from the AAFP Am Fam Physician, 91 (2015), pp. 197-198

5 A.C. Graham, J.H. McClure Quantitative assessment of motor block in labouring women receiving epidural analgesia Anaesthesia, 56 (2001), pp. 470-476

6 D. Song, F. Chung, J. Wong, et al. The assessment of postural stability after ambulatory anesthesia: a comparison of desflurane with propofol Anesth Analg, 94 (2002), pp. 60-64 table of contents

7 D. Moher, S. Hopewell, K.F. Schulz, et al. Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials J Clin Epidemiol, 63 (2010), pp. e1-37

8 J. Kim, W. Shin How to Do Random Allocation (Randomization) Clin Orthop Surg, 6 (2014), p. 103

9 H. Akabane, Y. Shimada, R. Ogawa Usefulness of posturography after epidural block J Nippon Med Sch, 71 (2004), pp. 35-43

10 D.J. Steward, G. Volgyesi Stabilometry: a new tool for the measurement of recovery following general anaesthesia for out-patients Can Anaesth Soc J, 25 (1978), pp. 4-6

11 A. Hiller, I. Pyykkö, L. Saarnivaara Evaluation of postural stability by computerised posturography following outpatient paediatric anaesthesia. Comparison of propofol/alfentanil/N2O anaesthesia with thiopentone/halothane/N2O anaesthesia Acta Anaesthesiol Scand, 37 (1993), pp. 556-561

12 C.D. Elton, P. Ali, M.C. Mushambi “Walking extradurals” in labour: a step forward? Br J Anaesth, 79 (1997), pp. 551-554

13 R.C. Etches, W.D. Writer, D. Ansley, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery Anesth Analg, 84 (1997), pp. 784-790

14 A. Opala-Berdzik, J.W. Błaszczyk, B. Bacik, et al. Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study PLoS One, 10 (2015), Article e0124207

15 J. McCrory, A. Chambers, A. Daftary, et al. Dynamic postural stability in pregnant fallers and non-fallers BJOG An Int J Obstet Gynaecol, 117 (2010), pp. 954-962

16 Y. Ginosar, E.T. Riley, M.S. Angst The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration Anesth Analg, 97 (2003), pp. 1428-1438

17 A.E. Pickering, M.G. Parry, B. Ousta, et al. Effect of combined spinal-epidural ambulatory labor analgesia on balance Anesthesiology, 91 (1999), pp. 436-441

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