Utjecaj intrapartalne analgezije petidinom ili tramadolom na opstetričke ishode – usporedbeno dvostruko slijepo randomizirano prospektivno intervencijsko istraživanje

Dražan Butorac, Ivka Djaković, Ana-Meyra Potkonjak, Krunoslav Kuna, Blaženka Sumpor, Mirjana Radošević Vrkljan, Vesna Košec

Cilj: Cilj istraživanja bila je usporedba djelovanja tramadola i petidina tijekom porođaja na opstetričke ishode (njihov analgetski učinak, trajanje porođaja, pojavnost nuspojava u rodilja i neonatalni status). Metode: Djelovanje analgetika ispitano je prospektivnim usporedbenim (engl. head-to-head) randomiziranim dvostruko slijepim intervencijskim istraživanjem na uzorku od 60 rodilja tijekom ročnog porođaja. U istraživanju su upotrijebljene doze tramadola i petidina od 50 mg primijenjene intravenski. Pri analizi podataka služili smo se testom razlike u proporcijama dvaju nezavisnih skupova i Studentovim t-testom. Prije provedbe t-testa normalnost je ispitana Kolmogorov-Smirnovljevim testom. Rezultati: Primjena tramadola povezana je s manje prijavljenih nuspojava te kraćim trajanjem porođaja u odnosu prema skupini rodilja liječenih petidinom. Analizom analgetskog učinka statistički značajno niža vrijednost boli nakon 10 minuta i 30 minuta utvrđena je u pacijentica kojima je primijenjen petidin u odnosu prema onima na tramadolu, uz negativnu razliku osjeta boli u obje promatrane točke mjerenja. Efekt primjene tramadola iščeznuo je nakon 30 minuta. Nisu utvrđene statistički značajne razlike u karakteristikama CTG zapisa, Apgarina zbroja, vrijednosti pH iz pupkovine. Zaključak: Prema rezultatima istraživanja, tramadol skraćuje trajanje porođaja, a petidin ima jači analgetski učinak, ali i više neugodnih nuspojava za majku. Neonatalni je ishod neovisan o vrsti opioida.

Objective: The aim of the study is to compare the effects of tramadol and pethidine during labor on the obstetrical outcomes (their analgesic effect, duration of labor, and the occurrence of adverse events in mother and neonate. Methods: The effect of analgesia was investigated by a prospective head-to-head randomized double-blind intervention study on a sample of 60 women in labor. In the study, 50 mg of tramadol and pethidine was administered intravenously. Data analysis was performed using tests of the difference of two independent proportions and Student’s tests. Prior to the comparison of groups, normality was tested using Kolmogorov-Smirnov test. Results: The use of tramadol is associated with side effects less frequently reported and a shorter labor duration compared to the use of pethidine. Compared to tramadol, a statistically significant lower level of pain was determined after ten minutes and 30 minutes in patients among whom pethidine was used. In the tramadol group, a negative difference in the sensation of pain was determined in both points of measurement that were observed. The effect of tramadol administration vanished after 30 minutes. There were no statistically significant differences in fetal heart rate characteristics, Apgar score, and fetal acid-base status at birth. Conclusion: According to the study, tramadol shortens the duration of labour, whereas pethidine has a stronger analgesic effect, but is also accompanied with more maternal side effects being reported. No difference in the neonatal outcome was found.