Writer W D, Stienstra R, Eddleston J M, Gatt S P, Griffin R, Gutsche B B, Joyce T H, Hedlund C, Heeroma K, Selander D
Department of Anaesthesia, IWK Grace Health Centre, Halifax, Canada.
Br J Anaesth. 1998 Nov;81(5):713-7. doi: 10.1093/bja/81.5.713.
In this prospective meta-analysis, we have evaluated the effect of epidural analgesia with ropivacaine for pain in labour on neonatal outcome and mode of delivery compared with bupivacaine. In six randomized, double-blind studies, 403 labouring women, primigravidae and multiparae, received epidural analgesia with ropivacaine or bupivacaine 2.5 mg ml-1. The drugs were administered as intermittent boluses in four studies and by continuous infusion in two. Apgar scores, neurological and adaptive capacity scores (NACS), degree of motor block and mode of delivery were recorded. The studies were designed prospectively to fit meta-analysis of the pooled results. Results showed similar pain relief and consumption of the two drugs. In the vaginally delivered neonates, NACS scores were approximately equal for both groups at 2 h, but at 24 h there were fewer infants with NACS less than 35 in the ropivacaine compared with the bupivacaine group (2.8% vs 7.6%; P < 0.05). Spontaneous vaginal deliveries occurred more frequently overall with ropivacaine than with bupivacaine (58% vs 49%; P < 0.05) and instrumental deliveries (forceps and vacuum extraction) less frequently (27% vs 40%; P < 0.01), while the frequency of Caesarean section was similar between groups. The intensity of motor block was lower with ropivacaine. There were no significant differences in adverse events.
在这项前瞻性荟萃分析中，我们评估了与布比卡因相比，罗哌卡因用于分娩镇痛对新生儿结局和分娩方式的影响。在六项随机双盲研究中，403名初产妇和经产妇在分娩时接受了2.5mg/ml的罗哌卡因或布比卡因硬膜外镇痛。在四项研究中，药物以间歇性推注的方式给药，在两项研究中以持续输注的方式给药。记录了阿氏评分、神经和适应能力评分（NACS）、运动阻滞程度和分娩方式。这些研究是前瞻性设计的，以适合对汇总结果进行荟萃分析。结果显示，两种药物的镇痛效果和用量相似。在经阴道分娩的新生儿中，两组在2小时时的NACS评分大致相等，但在24小时时，与布比卡因组相比，罗哌卡因组中NACS低于35分的婴儿较少（2.8%对7.6%；P<0.05）。总体而言，罗哌卡因组自然阴道分娩的发生率高于布比卡因组（58%对49%；P<0.05），器械助产（产钳和真空吸引）的发生率低于布比卡因组（27%对40%；P<0.01），而两组剖宫产的发生率相似。罗哌卡因引起的运动阻滞强度较低。不良事件方面无显著差异。
