Celeski D C, Heindel L, Haas J, Vacchiano C A
Naval Hospital, Okinawa, Japan.
AANA J. 1999 Jun;67(3):239-44.
The short duration of effective analgesia produced by intrathecal fentanyl (ITF) at doses ranging from 5 to 25 micrograms limits the drug's use for the management of labor pain. The understanding of the potential of ITF related to duration of analgesia in the labor patient is derived from studies of and clinical experience with ITF at doses not exceeding 25 micrograms and less. We hypothesized that by increasing the dose beyond 25 micrograms, a prolonged duration of analgesia could be achieved. The purpose of the present study was to compare the difference in duration of effective analgesia and adverse effects produced by 25, 37.5, and 50 micrograms of ITF. A sample population of 60 term parturient women with uncomplicated singleton pregnancies who were in active labor and requesting pain control were randomly assigned to 1 of 3 groups: group 1, 25 micrograms (n = 20); group 2, 37.5 micrograms (n = 20); and group 3, 50 micrograms (n = 20). The ITF was then administered by an anesthesia provider blinded to the dose via a combined spinal epidural technique. The time from injection to the time of request for subsequent pain control (considered the duration of effective analgesia), maternal and fetal vital signs, and adverse effects were recorded at specific intervals until the patient requested activation of the epidural catheter or delivery occurred, ending participation in the study. Statistical analysis using a 1-way analysis of variance and considering a P value of < .05 to be significant revealed no difference in duration of effective analgesia between the groups. Statistical differences in the incidence of adverse effects, particularly uterine hyperstimulation, hypotension, pruritus, nausea, and fetal heart rate decelerations were not evident using the Fisher Irwin test and a significance of P < .05. The findings of the present study demonstrate that there is no real advantage of using doses of ITF greater than 25 micrograms in quality and duration of effective labor analgesia.
鞘内注射芬太尼（ITF）剂量在5至25微克时产生的有效镇痛持续时间较短，限制了该药物在分娩疼痛管理中的应用。对ITF在分娩患者中与镇痛持续时间相关潜力的理解，源于对不超过25微克及更低剂量ITF的研究和临床经验。我们假设通过将剂量增加到25微克以上，可以实现更长时间的镇痛。本研究的目的是比较25微克、37.5微克和50微克ITF产生的有效镇痛持续时间和不良反应的差异。将60名足月单胎妊娠、处于活跃期分娩且要求控制疼痛的无并发症产妇随机分为3组：第1组，25微克（n = 20）；第2组，37.5微克（n = 20）；第3组，50微克（n = 20）。然后由对剂量不知情的麻醉人员通过联合腰麻硬膜外技术给予ITF。记录从注射到要求后续疼痛控制的时间（视为有效镇痛持续时间）、母婴生命体征以及特定时间间隔的不良反应，直至患者要求激活硬膜外导管或分娩发生，结束研究参与。使用单因素方差分析进行统计分析，将P值<0.05视为有统计学意义，结果显示各组间有效镇痛持续时间无差异。使用Fisher Irwin检验且P<0.05有统计学意义时，不良反应发生率，尤其是子宫过度刺激、低血压、瘙痒、恶心和胎儿心率减速的统计学差异并不明显。本研究结果表明，在有效分娩镇痛的质量和持续时间方面，使用大于25微克剂量的ITF并无实际优势。
