5th International Conference on Gynecology and Obstetrics

Sergei V Pismensky, MD, is a board-certified anesthesiologist and intensive care physician of the highest category with 21 years of clinical experience. In 2006, he graduated with honors from the Faculty of Fundamental Medicine at Lomonosov Moscow State University, followed by a residency at the N.V. Sklifosovsky Research Institute of Emergency Medicine (2006–2008). Since 2013, he has been practicing at the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, where he has served as the Head of the Department of Anesthesiology and Intensive Care since 2015. His specializations include obstetric anesthesia, chronic pain management, and osteopathy. He is an ERC-certified BLS/AED instructor, an active member of ESA, ESICM, and MNOAR, and frequently conducts perinatal center audits and telemedicine consultations. He has authored over 15 scientific publications and regularly presents at domestic and international congresses.

Background: Labor pain is a significant stressor that can cause central sensitization and chronic postpartum pain. While neuraxial analgesia remains the "gold standard" for pain relief, newer techniques like combined spinal-epidural (CSE) and dural puncture epidural (DPE) offer potential advantages over standard epidural analgesia (EA). However, foreign protocols heavily rely on intrathecal or epidural fentanyl, whereas Russian regulations restrict intrathecal opioids and strictly limit approved epidural adjuvants. Therefore, evaluating the efficacy and safety of these advanced neuraxial techniques using only drugs approved in the Russian Federation is highly required

Objectives: The aim of the work is the justification for the differentiated use of various methods of neuraxial labor analgesia during vaginal delivery, taking into account their impact on maternal hemodynamics and uteroplacental blood flow metrics.

Methods: A prospective study involving 240 patients during emergency deliveries was conducted at the at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia. Analgesia was carried out by EA (N=60), CSE (N=60) and DPE (N=60), the control group consisted of women with no pain relief (N=60). On 1, 3, 5, 7, 10, 15, 25, 30, 60, 90 and 120th minutes, data from parainfrared spectroscopy (NIRS), pain from VAS, bloop pressure, respiratory rate, and oxygenation of the blood were assessed.

Results: We have not seen NIRS decrease below 89% for either EA or CSE. All of methods (EA, CSE, DPE) provided effective, fast-onset and long-term anesthesia to the birth, manifested by statistically significant reduction of the severity of pain syndrome on VAS from 8 points to 1-3 points. The fastest analgesic effect was observed in the CSE group (1-3 min), then in the DPE group (3-10 min) and in the EA group (7-15 min). Reduction of pain severity was more significant in DPE (up to 1-2 points in VAS) compared to EA. The reduction of pain syndrome in CSE was more stable and lasting than in EA. The anesthesia methods used to have a high favorable safety profile, as blood pressure, heart rate and respiratory rate, as well as oximetry and oxygenation of the blood during the entire observation period were within normal values.

Conclusion: Modern neuraxial labor analgesia (especially the DPE technique) is safe for uteroplacental blood flow, protects the newborn from the hypoxic stress of unmanaged pain, and significantly increases maternal satisfaction, while the developed differentiated algorithm allows for an individualized approach to select the method with the optimal efficacy and safety profile.