Okutomi T, Mochizuki J, Amano K, Hoka S
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Reg Anesth Pain Med. 2000 May-Jun;25(3):228-34. doi: 10.1016/s1098-7339(00)90003-8.
Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome.
Twenty-eight parturients received continuous epidural bupivacaine 0.25% (4 mL/h) combined either with epinephrine (20 microg/h) (n = 13) or without epinephrine (n = 15) for analgesia during labor. If patients requested additional analgesia, an additional bolus of 1% or 1.5% lidocaine (6 to 10 mL) was administered.
The total amount of additional lidocaine was greater in the plain bupivacaine group (130 [0, 280] mg; median [25th, 75th percentile] with P < .05) than in the epinephrine group (0 [0, 60] mg). Epinephrine infusion did not alter the resistance of the uterine and umbilical arteries as measured by resistance index. The duration of the first or second stages of labor did not significantly differ in the 2 groups. Epinephrine infusion did not change the fetal heart rate or the blood gas data in the umbilical artery.
A low-dose epidural infusion of epinephrine decreased anesthetic requirements.
肾上腺素与局部麻醉药联合使用，可延长硬膜外镇痛时间，并降低局部麻醉药的血浆峰值浓度。在产科麻醉实践中，肾上腺素对子宫胎盘及胎儿的影响是存在争议的问题。我们设计了一项前瞻性、随机、双盲研究，以通过多普勒超声检查肾上腺素输注对镇痛质量、子宫或脐血流的影响，以及第一产程或第二产程的持续时间和胎儿结局。
28例产妇在分娩期间接受持续硬膜外输注0.25%布比卡因（4 mL/h），其中13例联合肾上腺素（20μg/h），15例不联合肾上腺素，用于镇痛。如果患者要求追加镇痛，则给予额外剂量的1%或1.5%利多卡因（6至10 mL）。
单纯布比卡因组追加利多卡因的总量（130 [0, 280] mg；中位数[第25、75百分位数]，P <.05）高于肾上腺素组（0 [0, 60] mg）。通过阻力指数测量，肾上腺素输注未改变子宫和脐动脉的阻力。两组第一产程或第二产程的持续时间无显著差异。肾上腺素输注未改变胎儿心率或脐动脉血气数据。
低剂量硬膜外输注肾上腺素可降低麻醉需求。
