Impact of Combined Spinal Epidural Analgesia on Biomolecular Mediators in Painless Labor: Insights from an Experimental Study in Indonesia

Background: Inflammation affects labor by influencing contractions and dilation. Pain, often linked to tissue ischemia, involves mediators like TNF-α, substance P (SP), and nitric oxide (NO). Neuraxial analgesia, including combined spinal epidural analgesia (SEA) with levobupivacaine, is preferred for its effectiveness and minimal side effects in painless labor. This study investigates these effects in parturients undergoing SEA with levobupivacaine, contributing to the development of novel pain medications and enhancing obstetric care. Methods: This study was conducted at Permata Hati Metro Hospital in Indonesia. 60 expectant mothers in active labor or in the third trimester scheduled for vaginal delivery were enrolled. Blood serum samples were collected for analysis, and to be processed by ELISA KIT for determining serum levels of TNF-α, SP, and NO. Results: Following treatment, there were no significant differences in TNF-α levels between groups before and after treatment (p > 0.05). Although no significant difference in SP levels was noted before treatment, a significant difference was evident after treatment (p < 0.05). Moreover, a significant reduction in NO levels was observed in the SEA group compared to the control group (p < 0.05). SEA significantly relieved labor pain compared to the control group (P < 0.05), accompanied by notable improvements in vital signs and APGAR scores and labor duration (P < 0.001). Conclusion: SEA with levobupivacaine during painless labor demonstrates a trend of decreasing TNF-α and SP levels while significantly reducing NO levels. Although some mediators did not show significance, clinical benefits were found in patients and babies.