| Background and purporse:Epidural analgesia is the standard method for labor pain analgesia.while unavoidable slower onset and overdosed with analgesics produce severe complications.Most of the women felt unbearable pain in the lumbosacral region during labor.Several lumbosacral acupoints on "Taiyang Bladder Meridian of Foot" have been used to treat lumbosacral pain.The purposes of this study are to explore an ideal acupoint in lumbosacral region when combined with epidural analgesia,and to compare the effect of acupoint injection on labor pain and birth process with epidural analgesia.The potential mechanisms underlying the acupoint in labor analgesia were also investigated.Materials and Methods:1 Comparation of the analgesic effects of different acupoint injection in lumbosacral region combined with epidural analgesia on labor pain A total of 80 pregnant women were randomly enrolled into the Shangliao point group,Ciliao point group,Baomang point group,Zhibian point group and the control group to compare their analgesic effects on labor painwhen combined with epidural analgesia.2 Comparation of the effects of different methods of Shangliao point injection combined with epidural analgesia on the pain and progress of labor2.1 According to the results of part 1,a total of 30 pregnant women were randomly assigned to intracutaneous injection group and subcutaneous injection group to compare the effects of injection intracutaneously or subcutaneously at Shangliao point on the labor pain and birthe progress when combined with epidural analgesia.2.2 According to the results of 2.1,a total of 45 pregnant women were randomly assigned into 0.5ml group,1ml group and 2ml group to compare the effects of injection different volume of saline intracutaneously at Shangliao point on the labor pain and birth progress when combined with epidural analgesia.2.3 According to the results of 2.2,a total of 64 pregnant women were randomly assigned into saline group,sterile water group,lidocaine group and fentanyl group to compare the effects of injection of different drugs intracutaneously at Shangliao point on the labor pain and birth progress when combined with epidural analgesia.3 Comparation of the effects of epidural analgesia on the progress and pain of labor with or without injection at Shangliao point3.1 According to the results of part 2,a total of 93 pregnant women were randomly assigned into the Shangliao point injection combined with epidural analgesia group(ES group)or epidural analgesia alone group(E group)to compare the effects of epidural analgesia on the labor pain and birth progress with or without injection of 2ml saline intradermally at Shangliao point3.2 A total of 14 pregnant women were enrolled to measure the changes of pelvic floor,ulterus contraction,plasma oxytocin(OT)and β-endorphin(β-EP)before and after Shangliao point injection.Tansperineal ultrasound(TPU)was applied to measure the angel of decent(Ao D)and anteroposterior diameter of the levator hiatus(APD).Results:1 Comparation of the effects of different acupoint injection in lumbosacral region combined with epidural analgesia on the pain and progress of labor Compared with the basic values,the NRS score in lumbosacral region during the first uterus contraction after Shangliao point injection,Ciliao point injection,Baomang point injection,Zhibian point injection and the Sham injection were significantly decreased,separately 4.9±2.3,3.5±1.8,2.6±1.9,3.4±2.0,and 0.0(0.0-0.0).All the acupoint injection groups improved labor pain significantly as evidenced by increased NRS score compared with control group(P<0.05).The NRS score in the Shangliao point injection group is significant higher than in other point injection groups(P<0.05).2 Comparation of the effects of different Shangliao point injection on the labor pain and birth progress when combined with epidural analgesia2.1For Shangliao point injection,the lumbosacral NRS score between the basic value and during the first contractions was 5.4±1.7 following intracutaneous injection,significantly higher than 1.4±1.5 for the subcutaneous injection group.(4.0,95% CI,2.8 ～ 5.2;P<0.001).There was no statistical difference of time interval from epidural analgesia to baby delivery between these two groups.2.2 Compared with the basic value,the lumbosacral NRS score decreased separatly by 5.5(4.0-6.0)in 2ml group,3.0(2.0-4.3)in 1ml group,and 2.0(1.5-4.0)in 0.5m L group after injection at Shangliao point.The NRS score decreased more significantly in the 2ml group than that in the 1ml group and 0.5m L group(P<0.01,P<0.01).There was no statistical difference of duration time from epidural analgesia to baby delivery among these three groups.2.3 In this study,sterile water group had to terminated as four pregnant women complained of severe pain during injection were all in sterile water group after uncovering the blind.The lumbosacral NRS score during the first uterus contraction was decreased after Shangliao point injection,with 6.2±2.4 for the saline group,3.0±1.9 for the lidocaine group,and 3.2±2.0 for the fentanyl group.The NRS score decreased in normal saline group was significantly higher than the lidocaine group and the fentanyl group(P< 0.001).There was no statistical difference of duration time from epidural analgesia to baby delivery between the three groups.3 Comparation the effects of epidural analgesia on the labor pain and birthprogress with or without Shangliao point injection3.1 The time interval from epidural analgesia to baby delivery was significantly shorter in ES group than that in E group(307.0(175.0-445.0)min VS 369.0(254.0-563.0)min,P=0.02).The dosage of drugs including ropivacaine and sufentanil used for epidural analgesia was significantly less in ES group than in E group(-18.4 ml,95%CI,-33.3～-3.5;P=0.02).Pain scores in lumbosacral area during the first uterus contraction and at 10 min after epidural administration were also lower in the ES group than the E group(P<0.001,P=0.02).3.2 The Ao P at rest and during Valsalva were inceased after shangliao point injection,(7.10°,95%CI,1.50～12.70;P=0.02);(9.10°,95%CI,3.60～14.58;P<0.01).The APD at rest and during valsalva were significantly increased after shangliao point injection,(0.27 cm,95%CI,0.03～0.51;P=0.03);(0.30 cm,95%CI,0.13～0.48;P<0.01).The APD at rest substract at maximum pelvic floor muscle contraction was significantly higher after Shangliao point injection than before,(0.22 cm,95%CI,0.09～0.35;P<0.01).There was no significant difference in the contents of plasm OT andβ-EP before and after Shangliao point injection(P=0.28,P=0.27).Conclusion:Intracutaneous injection of 2ml saline at Shangliao point can relieve the lumbosacral pain during labor effectively and quickly.When combined with epidural analgesia,injection of saline on Shangliao point intradermally could facilitate baby delivery,and relieve low back pain effectively and rapidly.The possible mechanisms of relief of lumbosacral pain by Shangliao point injection maybe gate control and relieve the spasm of the pelvic muscle.The possible mechanisms underlying accelerated labor process by Shangliao point injection included relaxation of pelvic floor muscles,increasement of pelvic muscle contraction and then promotion of fetal head decent. |
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