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      Effect of led photobiomodulation on analgesia during labor : Study protocol for a randomized clinical trial

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          Abstract

          Background:

          Labor pain is one of the most intense pains experienced by women, which leads to an increase in the number of women opting to undergo a cesarean delivery. Pharmacological and nonpharmacological analgesia methods are used to control labor pain. Epidural analgesia is the most commonly used pharmacological analgesia method. However, it may have side effects on the fetus and the mother. Light-emitting diode (LED) photobiomodulation is an effective and noninvasive alternative to pharmacological methods.

          Objectives:

          To evaluate the effects of LED photobiomodulation on analgesia during labor.

          Methods:

          In total, 60 women in labor admitted to a public maternity hospital will be selected for a randomized controlled trial. The participants will be randomized into 2 groups: intervention group [analgesia with LED therapy (n = 30)] and control group [analgesia with bath therapy (n = 30)]. The perception of pain will be assessed using the visual analogue scale (VAS), with a score from 0 to 10 at baseline, that is, before the intervention. In both the groups, the procedures will last 10 minutes and will be performed at 3 time points during labor: during cervical dilation of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm. At all 3 time points, pain perception will be evaluated using VAS shortly after the intervention. In addition, the evaluation of membrane characteristics (intact or damaged), heart rate, uterine dynamics, and cardiotocography will be performed at all time points.

          Expected outcomes:

          The use of LED photobiomodulation will have an analgesic effect superior to that of the bath therapy.

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          Most cited references31

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          Dose response effects of 810 nm laser light on mouse primary cortical neurons.

          In the past four decades numerous studies have reported the efficacy of low level light (laser) therapy (LLLT) as a treatment for diverse diseases and injuries. Recent studies have shown that LLLT can biomodulate processes in the central nervous system and has been extensively studied as a stroke treatment. However there is still a lack of knowledge on the effects of LLLT at the cellular level in neurons. The present study aimed to study the effect of 810 nm laser on several cellular processes in primary cortical neurons cultured from embryonic mouse brains. Neurons were irradiated with fluences of 0.03, 0.3, 3, 10, or 30 J/cm(2) of 810-nm laser delivered over varying times at 25 mW/cm(2) and intracellular levels of reactive oxygen species (ROS), nitric oxide and calcium were measured using fluorescent probes within 5 minutes of the end of irradiation. The changes in mitochondrial function in response to light were studied in terms of adenosine triphosphate (ATP) and mitochondrial membrane potential (MMP). Light induced a significant increase in calcium, ATP and MMP at lower fluences and a decrease at higher fluences. ROS was significantly induced at low fluences, followed by a decrease and a second larger increase at 30 J/cm(2). Nitric oxide levels showed a similar pattern of a double peak but values were less significant compared to ROS. The results suggest that LLLT at lower fluences is capable of inducing mediators of cell signaling processes which in turn may be responsible for the beneficial stimulatory effects of the low level laser. At higher fluences beneficial mediators are reduced and high levels of Janus-type mediators such as ROS and NO (beneficial at low concentrations and harmful at high concentrations) may be responsible for the damaging effects of high-fluence light and the overall biphasic dose response. Copyright © 2011 Wiley-Liss, Inc.
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            Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum-influence of epidural analgesia and oxytocin in the perinatal period.

            In this study we made a detailed analysis of the mothers' release pattern of adrenocorticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol. Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay. Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A positive and significant relationship was found between ACTH and cortisol levels. The duration of skin-to-skin contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin. Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and with median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.
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              Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan.

              To examine the effectiveness of a birth ball exercise programme during childbirth by measuring childbirth self-efficacy and childbirth pain. In addition, it tested the mediating effects of childbirth self-efficacy on the relationship between the birth ball exercise programme and childbirth pain. Randomised controlled trial. The study was conducted from December 2008 to November 2009, at two birth units, one at a regional hospital and one at a medical centre, with 600 and 1022 annual births, respectively. One hundred and eighty-eight expectant mothers were recruited (recruitment rate: 47%) and were allocated by block randomisation into the two arms of the study, but only 48 intervention and 39 control group participants completing the trial. The birth ball exercise programme consisted of a 26-page booklet and a 19-minute videotape, with periodic follow-ups during prenatal checks. All members of the experimental group were asked to practise the exercises and positions at home for at least 20 minutes three times a week for a period of 6-8 weeks. Each woman in the experimental group was given a birth ball for use during labour and encouraged every hour to choose the most comfortable positions, movements, and exercises. Both the experimental and control groups received standard nursing and midwifery care from hospital staff nurses in all aspects of pregnancy and childbirth. When cervical dilations were four centimetres and eight centimetres, the women completed demographic and obstetrics information, the Childbirth Self-efficacy Inventory (CBSEI), and the short form of the McGill Pain Questionnaire (SF-MPQ). Our study revealed that birth ball exercises provided statistically significant improvements in childbirth self-efficacy and pain. Specifically, self-efficacy had a 30-40% mediating effect on relationships between birth ball exercises and childbirth pain. Mothers in the experimental group had shorter first-stage labour duration, less epidural analgesia, and fewer caesarean deliveries than the control group. Clinical implementation of the birth ball exercise programme could be an effective adjunctive tool to improve childbirth self-efficacy and reduce pain among women in labour. On the basis of our mediating model, the results further suggest that confidence is greater after prenatal preparation powerfully related to decreased pain perception and decreased medication/analgesia use during labour. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                June 2018
                22 June 2018
                : 97
                : 25
                : e11120
                Affiliations
                [a ]Post-graduate Program in Biophotonics Applied in Health Sciences of Nove de Julho University
                [b ]Medical Undergraduate Course at Nove de Julho University, São Paulo, Brazil.
                Author notes
                []Correspondence: Lara Jansiski Motta, Universidade Nove de Julho, São Paulo, São Paulo 18130-430, Brazil (e-mail: larajmotta@ 123456terra.com.br ).
                Article
                MD-D-18-03263 11120
                10.1097/MD.0000000000011120
                6023678
                29924010
                6269f2b1-9858-46db-8485-074b0a445b3f
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 22 May 2018
                : 23 May 2018
                Categories
                3800
                Research Article
                Study Protocol Clinical Trial
                Custom metadata
                TRUE

                labor,light-emitting diode,pain,photobiomodulation
                labor, light-emitting diode, pain, photobiomodulation

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