Local anaesthetics dose effect
The effect of different local anaesthetics and their doses, used for labour pain relief with PCEA, on foetus: a randomized double blind controlled trial
Baliuliene, V., Ceseviciute, K., Macas, A., Rimaitis, K.
Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
Goal: to evalute the effect of different local anaesthetics (LA) and their doses, used for labour epidural analgesia, on foetus.

Methods: a randomized controlled trial of healthy primiparas was carried out at 2014-2016. Labour pain was relieved with LA and opioid fentanyl (2µg/ml). The patients were allocated into groups according to used LAs and different concentrations: B1-bupivacaine (B)0.0625%, B2-B0.1%, B3-B0.125%, L1-levobupivacaine (L)0.0625%, L2-L0.1%, L3-L0.125%. Umbilical cord gas was collected after delivery.

Results: 237 patients were enrolled, 9 patients were excluded, according to trial protocol. Groups were similar according to ASA class, age, gestational age, BMI, duration of delivery stages.
Birth weight and Apgar score in 1 and 5 minutes between groups doesn't differ.
Proper umbilical cord blood gas samples were taken for 162 (69.6%) patients. Umbilical cord gas pH between groups are similar.
The correlation between total dose of local anaesthetics and umbilical cord gas pH is weak, but significant (r=-0.18; p=0.02). Linear logistic regression revealed that when total dose of local anaesthetic increases 10 mg, that determines decrease of umbilical cord blood pH in 0.04 (B=7.3; p=0.03). And dose limit of LA, when influence to umbilical cord blood pH appears, is 62.19 mg.
The rate of foetal bradycardia, meconium in amniotic fluid and newborn O2 request between groups doesn't differ (p=0.35; 0.97;0,14 respectively).
The rate of cesarean section was significantly different between groups (p=0.038). No significant differences were detected when the rate of vaginal and instrumental delivery was compared between study groups (p=143; p=0.168, respectively).
Conclusionins: increassing dose of local anaesthetics affects mode of delivery and increase foetal acidosis.

	


02 / The effect of different local anaesthetics and their doses, used for labour pain relief with PCEA, on foetus: a randomized double blind controlled trial.