Fischer C, Blanié P, Jaouën E, Vayssière C, Kaloul I, Coltat J C
Departments of Anesthesia and Gynecology and Obstetrics, Poissy Hospital, Poissy, France.
Anesthesiology. 2000 Jun;92(6):1588-93. doi: 10.1097/00000542-200006000-00015.
This study compared the administration of 0.1% ropivacaine and 0.5 microg/ml sufentanil with that of 0.1% bupivacaine and 0.5 microg/ml sufentanil via patient-controlled epidural analgesia route during labor.
Two hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were randomized in a double-blind fashion to receive either 0.1% ropivacaine and 0.5 microg/ml sufentanil or 0.1% bupivacaine and 0.5 microg/ml sufentanil using a patient-controlled epidural analgesia pump (5-ml bolus dose, 10-min locked-out period, no basal infusion). Pain score on a visual analog scale, Bromage score (0-3), level of sensory block, patient-controlled epidural analgesia ratio, drug use, supplemental boluses, and side effects were recorded at 30 min and then hourly. Mode of delivery, duration of first and second stages of labor, umbilical cord pH, Apgar scores of the newborn, and a measure of maternal satisfaction were recorded after delivery.
No differences were seen between the two groups for pain scores on a visual analog scale during labor, volume of anesthetic solution used, mode of delivery, or side effects. Motor block during the first stage of labor was significantly less in the ropivacaine group than in the bupivacaine group (no motor block in 97.8 of patients vs. 88.3%, respectively; P < 0.01). Duration of the second stage of labor was shorter in the ropivacaine group (1.3 +/- 1.0 vs. 1.5 +/- 1.2 h [mean +/- SD]; P < 0.05). Maternal satisfaction was greater in the bupivacaine group (91 +/- 13 mm for contraction, 89 +/- 19 mm for delivery on a visual scale: 0 = not satisfied at all, 100 = fully satisfied) than in the ropivacaine group (84 +/- 21 and 80 +/- 25 mm; P < 0.0001). Patients in the ropivacaine group requested more supplemental boluses to achieve analgesia during the second stage of labor than those in the bupivacaine group (29.7 vs. 19.8%, respectively, requested one or more supplemental boluses; P < 0.05).
Delivered as patient-controlled epidural analgesia, 0.1% ropivacaine and 0.5 microg/ml sufentanil produce less motor block but are clinically less potent than 0.1% bupivacaine and 0.5 microg/ml sufentanil.
本研究比较了在分娩期间通过患者自控硬膜外镇痛途径给予0.1%罗哌卡因和0.5微克/毫升舒芬太尼与给予0.1%布比卡因和0.5微克/毫升舒芬太尼的情况。
200名单胎足月健康孕妇，胎儿为头先露，采用双盲法随机分组，使用患者自控硬膜外镇痛泵（5毫升推注剂量，10分钟锁定期，无基础输注），分别接受0.1%罗哌卡因和0.5微克/毫升舒芬太尼或0.1%布比卡因和0.5微克/毫升舒芬太尼。在30分钟时记录视觉模拟评分法的疼痛评分、布罗玛格评分（0 - 3分）、感觉阻滞平面、患者自控硬膜外镇痛比例、药物使用情况、追加推注量及副作用，之后每小时记录一次。分娩后记录分娩方式、第一产程和第二产程的持续时间、脐动脉血pH值、新生儿阿氏评分以及产妇满意度。
两组在分娩期间视觉模拟评分法的疼痛评分、所用麻醉溶液量、分娩方式或副作用方面均无差异。罗哌卡因组第一产程的运动阻滞明显低于布比卡因组（分别为97.8%的患者无运动阻滞 vs. 88.3%；P < 0.01）。罗哌卡因组第二产程持续时间较短（1.3 ± 1.0 vs. 1.5 ± 1.2小时[均数 ± 标准差]；P < 0.05）。布比卡因组产妇满意度高于罗哌卡因组（视觉评分法中宫缩时为91 ± 13毫米，分娩时为89 ± 19毫米：0表示完全不满意，100表示完全满意）（罗哌卡因组分别为84 ± 21和80 ± 25毫米；P < 0.0001）。罗哌卡因组患者在第二产程中为达到镇痛所需的追加推注量比布比卡因组多（分别有29.7%和19.8%的患者需要一次或多次追加推注；P < 0.05）。
作为患者自控硬膜外镇痛给药时，0.1%罗哌卡因和0.5微克/毫升舒芬太尼产生的运动阻滞较小，但临床效力低于0.1%布比卡因和0.5微克/毫升舒芬太尼。
