///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

Effect of Epidural Analgesia on Transthoracic Echocardiographic Parameters of Diastolic Function in Term Parturients

Abstract Number: S-19
Abstract Type: Original Research

Edward O O'Brien MD1 ; Martin Krause MD2; Anne E Shapiro DO3; David Gambling MD4; Martin Krause MD5; Flora M Li BS6

Background

Echocardiographic assessment of diastolic function during pregnancy has demonstrated that LV compliance deteriorates from early gestation to term.[1] The exact mechanism of this is not known, but activation of the sympathetic nervous system has been shown to contribute to impairment of LV performance in congestive heart failure, ischemic coronary disease and other hypertensive or pre-hypertensive disorders. Neuraxial analgesia invariably blunts the sympathetic output to the peripheral vasculature and can change peripheral and central hemodynamics, but the effect of neuraxial local anesthetics on maternal LV compliance has not been reported. We hypothesize that blunting of the sympathetic output might change LV diastolic function and propose to use trans-thoracic echocardiography (TTE) to investigate the existence and magnitude of such changes in a prospective, observational study.

Methods

After IRB approval and written informed consent, healthy term parturients were recruited and divided into two arms consisting of 34 patients each. One arm consisted of patients who receive continuous lumbar epidural (CLE) analgesia and, the other arm, patients who receive combined spinal-epidural (CSE) analgesia. Baseline data included: blood pressure (BP), heart rate (HR), fetal gestational age (EGA), maternal body mass index (BMI), pain score and IV fluids received . Prior to neuraxial analgesia, an apical 4-chamber(A4C) view of the LV was obtained using TTE. Pulsed-wave doppler measurments of peak early (E) and late or “atrial” (A) mitral inflow velocities were recorded and the E-deceleration time from peak flow of the early wave measured. Using the A4C view, tissue doppler measurment of early diastolic flow was obtained at the septal and lateral mitral annulus (e’). Approximately 1 hour after CSE or CLE, these measurements were repeated in the same subject. BP, HR, pain scores, vaso-active medicines (e.g. ephedrine) and IV fluids received were also recorded after CLE or CSE. E/A, E/e’and E-deceleration time was compared in each patient before and after neuraxial analgesia using a paired t-test.

Results

To date 19 patients have been enrolled. Two patients has no post-neuraxial data measured for obstetric reasons. Of the remaining 16 women, 9 had CSE and 7 had CLE. There were no differences in BP, HR or BMI between those receiving CLE vs. CSE. For those who got CSE, E/e’was lower after CSE (6.441 vs. 5.433, p<0.05). For those who got CLE, E/e’was not significantly different (5.223 vs. 6.431, p = 0.33). E/A ratios were not significantly different before and after either CSE or CLE.

Discussion

To date this study indicated that CSE but not CLE may reduce the E/e’ratio one hour after initiating the block in healthy term parturients. This suggests that in term parturients, CSE may be a more effective modality than CLE at improving diastolic compliance.

Ref: {1} Zentna D et al. Clin Sci 2009; 116: 599-606.

SOAP 2015