Rayburn W F, Smith C V, Leuschen M P, Hoffman K A, Flores C S
Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha.
Anesthesiol Rev. 1991 Jan-Feb;18(1):31-6.
Preliminary observations have shown that fentanyl citrate, a potent narcotic, is helpful during labor without undue side effects. This randomized prospective investigation compared the patient-controlled administration of fentanyl with that of administration by nurses on request. Eighty healthy women beginning active labor (cervical dilation 4 cm) at term were assigned to receive fentanyl intravenously by either patient-controlled administration (n=37) or nurse administration on demand (n=43). Pain intensity measurements during early and late labor revealed the degree of analgesia to be the same in both groups. The delay in setting up the infusion system and the short time between requesting analgesia and vaginal delivery were limitations with self-administration. Maternal oversedation and vomiting did not occur. Neonatal naloxone therapy was used infrequently, umbilical serum levels of fentanyl were the same in both groups, and postnatal neuroadaptive testing revealed comparable results in both groups. Despite the usefulness of fentanyl during labor, administration by the patient had no advantages over administration by the nurses in significantly reducing drug use, improving pain relief, or avoiding drowsiness.
初步观察表明，强效麻醉剂枸橼酸芬太尼在分娩过程中有用且无不当副作用。这项随机前瞻性研究比较了患者自控给予枸橼酸芬太尼与护士按需给药的情况。80名足月开始活跃分娩（宫颈扩张4厘米）的健康女性被分配通过患者自控给药（n = 37）或护士按需给药（n = 43）静脉注射枸橼酸芬太尼。分娩早期和晚期的疼痛强度测量显示两组的镇痛程度相同。自行给药的局限性在于建立输液系统的延迟以及请求镇痛与阴道分娩之间的时间较短。未发生产妇过度镇静和呕吐。很少使用新生儿纳洛酮治疗，两组脐血枸橼酸芬太尼水平相同，产后神经适应性测试显示两组结果相当。尽管枸橼酸芬太尼在分娩过程中有用，但患者自行给药在显著减少药物使用、改善疼痛缓解或避免嗜睡方面并不比护士给药更具优势。
