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Serum levels of nitric oxide metabolites during labour with or without combined spinal-epidural analgesia

Published online by Cambridge University Press:  01 September 2008

X. Chen ,
X. Qian ,
H. Chen  and
M. Dong
X. Chen
Affiliation:
Zhejiang University, School of Medicine, Women’s Hospital, Department of Anaesthesia, Hangzhou, China
X. Qian
Affiliation:
Zhejiang University, School of Medicine, Women’s Hospital, Department of Anaesthesia, Hangzhou, China
H. Chen
Affiliation:
Zhejiang University, School of Medicine, Women’s Hospital, Department of Anaesthesia, Hangzhou, China
M. Dong*
Affiliation:
Zhejiang University, School of Medicine, Women’s Hospital, Department of Anaesthesia, Hangzhou, China Zhejiang University, Key Laboratory of Women’s Reproductive Health of Zhejiang Province, Hangzhou, China
*
Correspondence to: Minyue Dong, Women’s Hospital, School of Medicine, Zhejiang University, 2 Xueshi Road, Hangzhou 310006, China. E-mail: mydong.cn@hotmail.com; Tel: +86 571 8706 1501, Ext. 1812; Fax: +86 571 870 61878
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Summary

Background and objective

Combined spinal-epidural analgesia is effective in labour analgesia. Nitric oxide may play important roles in pregnancy and labour and is probably affected by labour pain. The aim of the present study was to explore the alteration in serum levels of nitric oxide metabolites, i.e. nitrate and nitrite, during labour with or without combined spinal-epidural analgesia.

Methods

Fifty pregnant women were recruited at the cervical dilatation of 3∼4 cm, 25 received combined spinal-epidural analgesia and 25 served as control. Twenty in the combined spinal-epidural analgesia group and 19 in the control group finished data collection and were included in the analysis. Blood samples were taken at study entry, full cervical dilation and 2 h after delivery. Total serum level of nitrite and nitrate was measured with enzymatic conversion and followed by Griess reaction. Visual analogue pain scores and mean blood pressure were monitored.

Results

After analgesia, pain score and mean blood pressure were significantly lower in the combined spinal-epidural analgesia group than in the control group (P < 0.05). Serum levels of nitric oxide metabolites were not significantly different at study entry (P > 0.05) but significantly different at full cervical dilation and 2 h after delivery (P < 0.05 for both) between the control group and the combined spinal-epidural analgesia group. Serum levels of nitric oxide metabolites decreased significantly at full cervical dilation and 2 h after delivery compared with study entry in the control group (P < 0.05) and this decrease was almost abolished in the combined spinal-epidural analgesia group (P > 0.05).

Conclusions

Combined spinal-epidural analgesia provided effective analgesia and abolished the decrease in nitric oxide metabolites during active labour.

Keywords

NITRIC OXIDEANAESTHESIA EPIDURALANAESTHESIA SPINAL, combined spinal and epiduralLABOUR OBSTETRIC
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 9 , September 2008 , pp. 708 - 713
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Moncada, S, Palmer, RM, Higgs, EA. Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol Rev 1991; 43: 109–142.Google ScholarPubMed
2.Okawa, T, Vedernikov, YP, Saade, GR, Garfield, RE. Effect of nitric oxide on contractions of uterine and cervical tissues from pregnant rats. Gynecol Endocrinol 2004; 18: 186–193.CrossRefGoogle ScholarPubMed
3.Coumans, AB, Garnier, Y, Supcun, S, Jensen, A, Berger, R, Hasaart, TH. Nitric oxide and fetal organ blood flow during normoxia and hypoxemia in endotoxin-treated fetal sheep. Obstet Gynecol 2005; 105 (1): 145–155.CrossRefGoogle ScholarPubMed
4.Fox, SB, Khong, Ty. Lack of innervation of human umbilical cord: an immunohistological study. Placenta 1990; 11: 59–62.CrossRefGoogle Scholar
5.Learmont, JG, Poston, L. Nitric oxide is involved in flow-induced dilation of isolated human small fetoplacental arteries. Am J Obstet Gynecol 1996; 174: 583–588.CrossRefGoogle ScholarPubMed
6.Alderton, WK, Cooper, CE, Knowles, RG. Nitric oxide synthases: structure, function and inhibition. Biochem J 2001; 357: 593–615.CrossRefGoogle ScholarPubMed
7.Ledingham, MA, Thomson, AJ, Greer, IA, Norman, JE. Nitric oxide in parturition. BJOG 2000; 107 (5): 581–593.CrossRefGoogle ScholarPubMed
8.Sethuraman, R, Lee, TL, Chui, JW, Tachibana, S. Changes in amino acids and nitric oxide concentration in cerebrospinal fluid during labour pain. Neurochem Res 2006; 31 (9): 1127–1133.CrossRefGoogle Scholar
9.Nanno, H, Sagawa, N, Itoh, H et al. Nitric oxide metabolite concentrations in maternal plasma decrease during parturition: possible transient down-regulation of nitric oxide synthesis. Mol Hum Reprod 1998; 4 (6): 609–616.CrossRefGoogle ScholarPubMed
10.Hsu, MM, Chou, YY, Chang, YC, Chou, TC, Wong, CS. An analysis of excitatory amino acids, nitric oxide, and prostaglandin E2 in the cerebrospinal fluid of pregnant women: the effect on labour pain. Anesth Analg 2001; 93: 1293–1296.CrossRefGoogle Scholar
11.Simmons, SW, Cyna, AM, Dennis, AT, Hughes, D. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2007; 18 (3): CD003401.Google Scholar
12.Dong, MY, Shi, YF, Cheng, Q. Increased nitric oxide in peritoneal fluid from women with idiopathic infertility and endometriosis. J Reprod Med 2001; 46: 887–891.Google Scholar
13.Jo, T, Takauchi, Y, Nakajima, Y, Fukami, K, Kosaka, H, Terada, N. Maternal or umbilical venous levels of nitrite/nitrate during pregnancy and at delivery. In Vivo 1998; 12: 523–526.Google ScholarPubMed
14.Yanik, FF, Amanvermez, R, Kocak, I, Yanik, A, Celik, C. Serum nitric oxide and glutathione levels in preeclamptic and normotensive women during labour. Gynecol Obstet Invest 2001; 51 (2): 110–115.CrossRefGoogle Scholar
15.Chen, DC, Huang, YC, Wu, GJ. Serum nitric oxide changes in spontaneous and induced labour. Int J Gynaecol Obstet 2001; 75 (1): 75–77.CrossRefGoogle Scholar
16.Alehagen, S, Wijma, B, Lundberg, U, Wijma, K. Fear, pain and stress hormones during childbirth. J Psychosom Obstet Gynaecol 2005; 26 (3): 153–165.CrossRefGoogle ScholarPubMed
17.Chang, JY, Liu, LZ. Catecholamines inhibit microglial nitric oxide production. Brain Research Bulletin 2000; 52 (6): 525–530.CrossRefGoogle ScholarPubMed
18.Ochedalski, T, Zylinska, K, Laudanski, T, Lachowicz, A. Corticotrophin-releasing hormone and ACTH levels in maternal and fetal blood during spontaneous and oxytocin-induced labour. European J Endocrino 2001; 144: 117–121.CrossRefGoogle ScholarPubMed
19.Maltau, JM, Eielsen, OV, Stokke, KT. Effect of stress during labour on the concentration of cortisol and estriol in maternal plasma. Am J Obstet Gynecol 1979; 134 (6): 681–684.CrossRefGoogle ScholarPubMed
20.Wallerath, T, Witte, K, Schafer, SC et al. Down-regulation of the expression of endothelial NO synthase is likely to contribute to glucocorticoid-mediated hypertension. Proc Natl Acad Sci USA 1999; 96: 13357–13362.CrossRefGoogle ScholarPubMed
21.Wallerath, T, Codecke, A, Molojavyi, A, Li, H, Schrader, J, Forstermann, U. Dexamethason lacks effect on blood pressure in mice with a disrupted endothelial NO synthase gene. Nitric Oxide 2004; 10 (1): 36–41.CrossRefGoogle ScholarPubMed
22.Stevens, RA, Frey, K, Liu, SS, Kao, TC, MikatStevens, M, Morales, M. Sympathetic block during spinal anaesthesia in volunteers using lidocaine, tetracaine, and bupivacaine. Reg Anesth 1997; 22 (4): 325–331.CrossRefGoogle ScholarPubMed
23.Gonca, S, Kilickan, L, Dalcik, C, Dalcik, H, Bayindir, O. The cardioprotective effects of thoracal epidural anesthesia are induced by the expression of vascular endothelial growth factor and inducible nitric oxide synthase in cardiopulmonary bypass surgery. J Cardiovasc Surg (Torino) 2007; 48 (1): 93–102.Google ScholarPubMed
24.Rosselli, M. Nitric oxide and reproduction. Mol Hum Reprod 1997; 3 (8): 639–641.CrossRefGoogle ScholarPubMed
25.Woodman, CR, Price, EM, Laughlin, MH. Shear stress induces eNOS mRNA expression and improves endothelium-dependent dilation in senescent soleus muscle feed arteries. J Appl Physiol 2005; 98: 940–946.CrossRefGoogle ScholarPubMed
26.Lyamina, NP, Dolotovskaya, PV, Lyamina, SV, Malyshev, IY, Manukhina, EB. Nitric oxide production and intensity of free radical processes in young men with high normal and hypertensive blood pressure. Med Sci Monit 2003; 9 (7): CR304–CR310.Google ScholarPubMed
27.Suleiman, MY, Passannante, AN, Onder, RL, Greene-Helms, WF, Perretta, SG. Alteration of renal blood flow during epidural anesthesia in normal subjects. Anesth Anal 1997; 84: 1076–1080.CrossRefGoogle ScholarPubMed
28.Dresner, M, Bamber, J, Calow, C, Freeman, J, Charlton, P. Comparison of low-dose epidural with combined spinal-epidural analgesia for labour. Br J Anaesth 1999; 83 (5): 756–760.CrossRefGoogle ScholarPubMed
29.Moschini, V, Marra, G, Dabrowska, D. Complications of epidural and combined spinal-epidural analgesia in labour. Minerva Anesthsiol 2006; 72: 47–58.Google ScholarPubMed
30.Tsen, LC, Thue, B, Datta, S, Segal, S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999; 91 (4): 920–925.CrossRefGoogle ScholarPubMed
31.Rahm, VA, Hallgren, A, Hogberg, H, Hurtig, I, Odlind, V. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand 2002; 81 (11): 1033–1039.CrossRefGoogle ScholarPubMed