Lee B B, Ngan Kee W D, Hung V Y, Wong E L
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China.
Br J Anaesth. 1999 Dec;83(6):868-71. doi: 10.1093/bja/83.6.868.
We have compared intrathecal bupivacaine 1.25 mg and fentanyl 25 micrograms (group A) with bupivacaine 2.5 mg and fentanyl 25 micrograms (group B), for combined spinal-epidural analgesia in 49 labouring parturients in a prospective, randomized, double-blind study. Onset and quality of analgesia were similar in both groups, with median visual analogue scale pain scores of 0 achieved in 5-10 min. Median duration of analgesia was longer in group B (median 120 (range 90-120) min) compared with group A (75 (75-105) min) (P = 0.013). Median upper sensory level was higher in group B compared with group A at 15 min (T6-7 vs T11, P = 0.003) and at 30 min (T6 vs T11-12; P = 0.001). Motor block was greater in group B: seven patients had a modified Bromage score > or = 1 compared with none in group A at 15 min (P = 0.017). Group B also had a greater decrease in arterial pressure. Patient-midwife satisfaction scores and other side effects were similar. We conclude that intrathecal bupivacaine 1.25 mg with fentanyl 25 micrograms provided analgesia of similar onset and quality compared with bupivacaine 2.5 mg and fentanyl 25 micrograms. Although the duration of analgesia was shorter, the incidences of motor block and hypotension were less with the smaller dose.
在一项前瞻性、随机、双盲研究中，我们将49例分娩产妇分为两组，分别接受鞘内注射1.25mg布比卡因加25μg芬太尼（A组）和2.5mg布比卡因加25μg芬太尼（B组）进行腰麻-硬膜外联合镇痛。两组镇痛的起效时间和质量相似，5-10分钟内视觉模拟评分法疼痛评分中位数均达到0。B组镇痛持续时间中位数（120（90-120）分钟）长于A组（75（75-105）分钟）（P=0.013）。15分钟时B组感觉平面上界中位数高于A组（T6-7 对比 T11，P=0.003），30分钟时也是如此（T6 对比 T11-12；P=0.001）。B组运动阻滞更明显：15分钟时，B组有7例患者改良Bromage评分≥1分，而A组无（P=0.017）。B组动脉压下降也更明显。患者-助产士满意度评分及其他副作用相似。我们得出结论，鞘内注射1.25mg布比卡因加25μg芬太尼与2.5mg布比卡因加25μg芬太尼相比，镇痛起效时间和质量相似。虽然镇痛持续时间较短，但较小剂量时运动阻滞和低血压的发生率较低。
