Chen L K, Hsu H W, Lin C J, Huang C H, Tsai S K, Lee C N, Hsieh F J
Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2000 Jul;99(7):549-53.
It is generally accepted that epidural injection with local anesthetics and narcotics administered when the cervix has dilated to a diameter exceeding 4 cm can adequately control labor pain. However, many nulliparous women still suffer from labor pain for a few hours prior to the administration of epidural analgesia. This study examined the effectiveness of relief of labor pain obtained by injection of narcotics epidurally once the labor pain begins and the subject requests analgesia.
Subjects scheduled for induced labour were divided into three groups: Group A (n = 60) received 5 x 10(-4)% fentanyl (10-20 mL) administered epidurally to relieve early first-stage labor pain. Group B (n = 60) received no analgesic in the early first stage of labor. For groups A and B, when cervical dilatation exceeded 4 cm, 10 to 15 mL of 5 x 10(-2)% bupivacaine and 2 x 10(-4)% fentanyl were injected epidurally and a continuous low dosage was maintained until full dilatation of the cervix resulted. Group C (n = 198) received no analgesic during the entire labor course.
There were no significant differences in the duration of the early period of the first stage of labor, the duration of the late period of the first stage, the duration of the second stage, the Apgar score, or the arterial blood gas of neonates among the three groups. However, group C had a significantly higher cesarean section rate (28.8%) than group A (16.7%) or group B (15%). Pain scores assessed with the Visual Analog Scale (VAS) throughout the entire labor course, were lower in group A than in group B; particularly during the early period of the first stage. The VAS scores in both groups A and B were significantly lower than those in group C during the late period of the first stage of labor.
The results indicate that once labor pain begins and the subject requests analgesia, epidural injection with fentanyl alone can relieve labor pain during the early period of the first stage. The analgesia does not cause adverse effects to the mothers or neonates. In addition, the labor course and the method of delivery are not affected.
一般认为，当宫颈扩张至直径超过4厘米时，硬膜外注射局部麻醉药和麻醉性镇痛药可充分控制分娩疼痛。然而，许多初产妇在硬膜外镇痛给药前仍会经历数小时的分娩疼痛。本研究探讨了一旦分娩疼痛开始且受试者要求镇痛时，硬膜外注射麻醉性镇痛药缓解分娩疼痛的有效性。
计划引产的受试者分为三组：A组（n = 60）硬膜外注射5×10⁻⁴%芬太尼（10 - 20毫升）以缓解第一产程早期疼痛。B组（n = 60）在第一产程早期不给予镇痛。对于A组和B组，当宫颈扩张超过4厘米时，硬膜外注射10至15毫升5×10⁻²%布比卡因和2×10⁻⁴%芬太尼，并维持持续低剂量直至宫颈完全扩张。C组（n = 198）在整个分娩过程中不给予镇痛。
三组在第一产程早期持续时间、第一产程晚期持续时间、第二产程持续时间、新生儿阿氏评分或动脉血气方面无显著差异。然而，C组剖宫产率（28.8%）显著高于A组（16.7%）或B组（15%）。整个分娩过程中用视觉模拟评分法（VAS）评估的疼痛评分，A组低于B组；尤其是在第一产程早期。在第一产程晚期，A组和B组的VAS评分均显著低于C组。
结果表明，一旦分娩疼痛开始且受试者要求镇痛，单独硬膜外注射芬太尼可缓解第一产程早期的分娩疼痛。该镇痛对母亲或新生儿无不良影响。此外，不影响分娩过程和分娩方式。
