Background:
Inflammation influences contractions and dilation during labor. Pain, often linked to tissue ischemia, involves mediators like nitric oxide (NO), tumor necrosis factor-α (TNF-α), and substance P (SP). Neuraxial analgesia, including combined spinal epidural analgesia (SEA) with levobupivacaine, is preferred in painless labor because of its effectiveness and minimal side effects. Understanding the impact of painless labor techniques on biomolecular parameters such as NO, TNF-α, and substance P levels is crucial for improving pain management strategies. This study investigated these effects in parturients undergoing SEA with levobupivacaine thus helping develop novel pain medications and enhanced obstetric care.
Methods:
This experimental study conducted at a general hospital in Indonesia involved 60 gravidas in labor or the third trimester who were expected to give birth vaginally at the Permata Hati Metro Hospital. Blood serum was used for analysis, and serum NO, TNF-α, and SP levels were assessed using ELISA.
Results:
NO levels decreased significantly before and after treatment in the SEA group compared to those in the control group (P < 0.05). However, TNF-α levels before and after treatment did not differ significantly between groups (P > 0.05). SP levels differed significantly between groups only after treatment (P < 0.05). SEA significantly reduced labor pain compared to the control group (P < 0.05), with vital signs and APGAR scores improving significantly and labor shortening (P < 0.001).
Conclusion:
SEA with levobupivacaine during painless labor reduces NO levels significantly and shows a trend of decreasing TNF-α and substance P levels, although not statistically significant, with clinical benefits for both patients and babies.
Key words: Labor Pain, Neuraxial Analgesia, Nitric Oxide, Tumor Necrosis Factor-alpha, Substance P
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