Jurnal Epidural FIX Terbaru

8/13/2019 Jurnal Epidural FIX Terbaru

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Oleh :

Ferdi

Pembimbing :

Dr. H. Zulkifli, Sp.An, M.Kes


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Child birth is most paintful experiences a woman canunder go

This experience may have long-term andpsychological effects

The neuroaxial analgesia has surpassed

The current standart labor epidural analgesic regimensconsist


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IEB

compared CEI

PatientSatisfaction

ts

The need formanual

anesthesiaintervension

Laborprogessio

n

Modeof

delivery


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MEDLINE,

CENTRAL,EMBASE Original authors were

contact and asked forany clarification ofprimary outcomemeasures

Informationsources

and search

strategy


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Study Identification

All Publish RCTs comparing IEB and CEI

Healthy laboring women (nullipara & Para)

With lumbar epidural catheter placed

Primary outcome: patient satisfaction,anesthesia intervension & mode of delivery

Secondary: motor blockade, degree ofsensory blockade n side effect


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Data extract by 2 authors Data presented asmedians,range and CI, themean and standart deviationwere calculated AP < 0.1was consideredstatisically significantheterogenity I2 > 50 was considered toindicate significantheterogenity


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RESULTS

21 articles were selected for in depth fulltext article

9 articles were deemed eligible forinclusion

12 articles were exclude

344 subject received CEI

350 subject received IEB


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8 reported data on the mode ofdelivery

Studies included 652 subject

None of this studies reported asignificant difference in the CD rate

Mode of Delivery


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There was no statistically significant

different in total duration of labor

between IEB and CEI

the duration in second stage of labor

was statistically significantly shortened

in IEB group


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Sia et al., reported no significant difference in the

pain-free interval between CEI and IEB.

Wong et al., did report the time to first PCEAusage, and this was not significantly different

between the IEB and CEI groups.


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3 published data regarding the total dose of localanesthesia

5 studies reported the total dose given

There was a statically significant reduction in totallocal anesthesia with IEB

There was no publication bias for local anestheticconsumption


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4 studies reported with VRS with 0dissatisfied & 100 is extremely

satisfied

Wong et al reported satisfaction withVAS score

There was no publication bias formaternal satisfaction


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Subgroup Analysis of Primary Outcomes

Outcome base on 1. the use of CSE to initiatelabor analgesia 2. the use of PCEA duringmaintenance of labor analgesia

CSE did not have significant effect on any primaryoutcomes

PCEA


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Additiona

loutcomes

All Publish RCTs

comparing IEBand CEI

Healthylaboringwomen

(nullipara

& Para)

With lumbar epiduralcatheter placed

Primary outcome:patient satisfaction,

anesthesia intervension& mode of delivery

Secondary: motorblockade, degree of

sensory blockade n sideeffect


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Discussion

21

articleswereselectedfor indepthfull textarticle

9

articleswere

deemedeligible

forinclusion

12articleswereexclude

344subjectreceivedCEI

350subjectreceivedIEB


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9 high-quality low risk bias of RCTs

Evaluate IEB and CEI in labouring women

Mode ofmaintenance

Mode ofdelivery

Intermittent bolus

Reduced

local

consumption

Reduce

d

dose

No significant

effect

Reduce

d

Labour

time


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Studies

Small sample

Should be interpreted with caution

nstrument delivery

rate

Duration

of deliveryImprovement of

Maternal satisfactio


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IEB

Reduced local

anesthetic

consumption

Shorter secondstage of labour

Higher maternal

satisfaction

CEI

Higher dose

required

Longer first stage of

labour

Lower maternal

satisfaction


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Terima Kasih

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Jurnal Epidural FIX Terbaru