Эпидуральная аналгезия в родах. Какой объем информации необходимо предоставить женщине?
DOI:
https://doi.org/10.15574/PP.2019.77.12Ключевые слова:
роды, эпидуральная аналгезия, осложнения, разъяснение пациенту, информированное согласиеАннотация
Одним из главных условий правомерности согласия на медицинское вмешательство является информированность пациента. Согласие на эпидуральную анальгезию в родах уникально. Вопрос автономии и компетентности украинских пациенток является спорным из-за низкого уровня осведомленности об обезболивании родов на этапе антенатального консультирования. Часто беременные женщины впервые встречаются с анестезиологом непосредственно в родах, когда время для ознакомления с информацией и принятия осознанного решения крайне ограничено. В статье освещены основные проблемные вопросы информирования женщин перед получением согласия на эпидуральную анальгезию в родах у здоровых женщин. Представлен опыт анестезиологов Винницкого областного перинатального центра, которые проводят информирование беременных об эпидуральной аналгезии в родах с помощью информационного бюллетеня «Эпидуральная аналгезия и роды» на этапе дородового консультирования, что существенно уменьшает этические и практические сложности, связанные с необходимостью детального разъяснения рисков аналгезии пациентке на фоне сильной боли в родах. С позиций доказательной медицины рассмотрены риски и преимущества эпидуральной анальгезии в родах, что должно быть базисом для консультирования беременных. Показано, что анестезиологи должны быть осведомлены о современных доказательных данных относительно рисков и преимуществ эпидуральной аналгезии в родах, а также о современных стандартах предоставления информации пациентам.
Библиографические ссылки
Dragan VV, Mednis DYu, German АА, Fedulichev PN, Anikin AE. (2011). Recommendation legalization of informed consent by the example of orthopedic surgery. Modern medical technologies. 2: 90-99.
Sakalo VА. (2012).The Informed Consent to Medical Interference: Bioethics Aspect. Law forum. 2: 609-613.
Salnikov VP. (2002). Informed Consent Doctrine. New legal thought. 1: 36-42.
Anim–Somuah M, Smyth RMD, Cyna AM, Cuthbert A. (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. Issue 5, Art. No.: CD000331. https://doi.org/10.1002/14651858.CD000331.pub4; PMid:29781504
Bannister–Tyrrell M, Ford JB, Morris JM, Roberts CL. (2014). Epidural analgesia in labour and risk of caesarean delivery. Paediatric and Perinatal Epidemiology. 28 (5): 400—411. https://doi.org/10.1111/ppe.12139; PMid:25040829
Bethune L, Harper N, Lucas DN, Robinson NP, Cox M, Lilley A, Yentis SM. (2004). Complications of obstetric regional analgesia: how much information is enough? Int J Obstet Anesth. 13 (1): 30—34. https://doi.org/10.1016/S0959-289X(03)00102-X
Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. (2005). Obstetric anesthesia workforce survey: Twenty-year update. 103 (3): 645—653. https://doi.org/10.1097/00000542-200509000-00030; PMid:16129992
Chambers DJ, Howells ACL. (2016). Neurological complications in obstetric regional anaesthesia. Anaesth and Intens Care. 17 (8): 372—374. https://doi.org/10.1016/j.mpaic.2016.05.006
Clark V. (2006). Women should be told ALL risks before regional anaesthesia is performed. Int J Obstet Anesth. 15 (4): 303—305. https://doi.org/10.1016/j.ijoa.2006.07.002; PMid:16949274
Collis RE, Davies DW, Aveling W. (1995). Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet. 345 (8962): 1413—1416. https://doi.org/10.1016/S0140-6736(95)92602-X
Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. (2001). Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet. 358 (9275): 19—23. https://doi.org/10.1016/S0140-6736(00)05251-X
Cook TM, Counsell D, Wildsmith JA; Royal College of Anaesthetists Third National Audit Project. (2009). Major complications of central neuraxial block: Report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 102 (2): 179—190. https://doi.org/10.1093/bja/aen360; PMid:19139027
Cuypers V, Van de Velde M, Devroe S. (2016). Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth. 25: 58—65. https://doi.org/10.1016/j.ijoa.2015.09.003; PMid:26597409
D'Angelo R, Smiley RM, Riley ET, Segal S. (2014). Serious complications related to obstetric anesthesia. Anesthesiology. 120 (6): 1505—1512. https://doi.org/10.1097/ALN.0000000000000253; PMid:24845921
Davies JM, Posner KL, Lee LA, Cheney FW, Domino KB. (2009). Liability associated with obstetric anesthesia. Anesthesiology. 110 (1): 131—139. https://doi.org/10.1097/ALN.0b013e318190e16a; PMid:19104180
Djakoviс I, Saboloviс Rudman S, Kosec V. (2017). Effect of epidural analgesia on mode of deliver. Wien Med Wochenschr. 167 (15—16): 390—394. https://doi.org/10.1007/s10354-016-0511-9; PMid:27604767
Doblar DD, Schumacher SD. (2005). Spontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor. Int J Obstet Anesth. 14 (3): 256—260. https://doi.org/10.1016/j.ijoa.2004.09.009; PMid:15935638
Duncan A, Patel S. (2016). Neurological complications in obstetric regional anesthetic practice. J Obstet Anaesth Crit Care. 6 (4): 3—10. https://doi.org/10.4103/2249-4472.181055
Dyer RA, Hodges O. (2007). Informed consent for epidural analgesia in labour. SAJAA. 13 (1): 27—34. https://doi.org/10.1080/22201173.2007.10872462
General Medical Council. Consent: patients and doctors making decisions together. London: GMC, 2008. URL: http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_contents.asp (accessed20/10/2016).
Hoehner PJ. (2003). Ethical aspects of informed consent in obstetric anesthesia — new challenges and solutions. J Clin Anesth. 15 (8): 587—600. https://doi.org/10.1016/S0952-8180(02)00505-6
Hunningher A, Bell R. (2004). Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 92 (5): 768—770. https://doi.org/10.1093/bja/aeh558; PMid:15113766
Kelly GD, Blunt C, Moore PA, Lewis M. (2004). Consent for regional anaesthesia in the United Kingdom: what is material risk? Int J Obstet Anesth. 13 (2): 71—74. https://doi.org/10.1016/j.ijoa.2003.08.002; PMid:15321407
Landau R. (2006). Women need to be told ALL the risks before regional techniques are performed. Int J Obstet Anesth. 15 (4): 301—303. https://doi.org/10.1016/j.ijoa.2006.07.001; PMid:16949812
National Collaborating Centre for Women's and Children's Health. Intrapartum Care. Care of healthy women and their babies during childbirth. Clinical Guideline. London: RCOG Press; 2014.
Nelson KE, Eisenach JC. (2005). Intravenous butorphanol, meperidine, and their combination relieve pain and distress in women in labor. Anesthesiology. 102 (5): 1008—1013. https://doi.org/10.1097/00000542-200505000-00021; PMid:15851889
Nystedt A, Edvardsson D, Willman A. (2004). Epidural analgesia for pain relief in labour and childbirth: A review with a systematic approach. Journal of Clinical Nursing. 13 (4): 455—466. https://doi.org/10.1046/j.1365-2702.2003.00849.x; PMid:15086632
Obstetric Anaesthetists' Association, Association of Anaesthetists of Great Britain and Ireland. (2013). OAA/AAGBI Guidelines for obstetric anaesthetic services 2013. London: AAGBI, 2013.
Olofsson C, Ekblom A, Ekman–Ordeberg G, Hjelm A, Irestedt L. (1996). Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br J Obstet Gynaecol. 103 (10): 968—972. https://doi.org/10.1111/j.1471-0528.1996.tb09545.x
Plaat F, McGlennan A. (2004). Women in the 21st century deserve more information: disclosure of material risk in obstetric anaesthesia. Int J Obstet Anesth. 13 (2): 69—70. https://doi.org/10.1016/j.ijoa.2004.01.001; PMid:15321406
Rice I, Wee MY, Thomson K. (2004). Obstetric epidurals and chronic adhesive arachnoiditis. Br J Anaesth. 92 (1): 109—120. https://doi.org/10.1093/bja/aeh009; PMid:14665562
Roelants F, Lavand-homme PM, Fuzier M-V. (2005). Epidural administration of neostigmine and clonidine to induce labor analgesia: evaluation of efficacy and local anesthetic-sparing effect. Anesthesiology. 102 (6): 1205—1210. https://doi.org/10.1097/00000542-200506000-00021; PMid:15915034
Royal College of Anaesthetists. (2018). Guidelines for the Provision of Anaesthesia Services for an Obstetric Population 2018. URL: https://www. rcoa.ac.uk/system/files/GPAS-2018-09-OBSTETRICS.pdf.
Ruppen W, Derry S, McQuay H, Moore RA. (2006). Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology. 105 (2): 394—399. https://doi.org/10.1097/00000542-200608000-00023; PMid:16871074
Smith AМ. (2001). Obtaining consent for examination and treatment. BMJ. 322 (7290): 810—811. https://doi.org/10.1136/bmj.322.7290.810; PMid:11290622 PMCid:PMC1119995
Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT. (2014). Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. (10): CD007238. https://doi.org/10.1002/14651858.CD007238.pub2; PMid:25300169
Stewart A, Sodhi V, Harper N, Yentis SM. (2003). Assessment of the effect upon maternal knowledge of an information leaflet about pain relief in labour. Anaesthesia. 58 (10): 1015—1019. https://doi.org/10.1046/j.1365-2044.2003.03360.x; PMid:12969045
Swan HD, Borshoff DC. (1994). Informed consent — recall of risk information following epidural analgesia in labour. Anaesth Intensive Care. 22 (2): 139—141. https://doi.org/10.1177/0310057X9402200202; PMid:8210014
Tsui MH, Ngan Kee WD, Ng FF, Lau TK. (2004). A double blinded randomised placebocontrolled study of intramuscular pethidine for pain relief in the first stage of labour. BJOG. 111 (7): 648—655. https://doi.org/10.1111/j.1471-0528.2004.00160.x; PMid:15198753
Wada K, Charland LC, Bellingham G. (2018). Can women in labor give informed consent to epidural analgesia? Bioethics. https://doi.org/10.1111/bioe.12517; PMid:30358905. Epub ahead of print.
Wang TT, Sun S, Huang SQ. (2017). Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 124 (5): 1571—1580. https://doi.org/10.1213/ANE.0000000000001709; PMid:27828798
Wee M. (2005). How painful is labour? Women's Health Medicine. 2 (4): 15—16. https://doi.org/10.1383/wohm.2005.2.4.15
WHO recommendation on epidural analgesia for pain relief during labour. (2018). URL: https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-1st-stage/who-recommendation-epidural-analgesia-pain-relief-during-labour.
Yentis SM, Hartle AJ, Barker IR, Barker P, Bogod DG, Clutton–Brock TH, et al. (2017). AAGBI: Consent for anaesthesia 2017. 72 (1): 93—105. https://doi.org/10.1111/anae.13762; PMid:27988961
Yoshii WY, Rottman RL, Rosenblatt RM. (1994). Epidural catheter-induced traumatic radiculopathy in obstetrics. Reg Anesth and Pain Med. 19(2): 132—135.
