三种剂量舒芬太尼联合布比卡因-肾上腺素用于分娩期连续硬膜外镇痛的比较

Eriksson S L, Frykholm P, Stenlund P M, Olofsson C

Department of Anaesthesiology and Intensive Care, Gävle-Sandviken County Hospital, Stockholm, Sweden.

Acta Anaesthesiol Scand. 2000 Sep;44(8):919-23. doi: 10.1034/j.1399-6576.2000.440804.x.

BACKGROUND

Sufentanil is now frequently added to local anaesthetic in labour epidural analgesia. However, this opioid has some side effects such as pruritus, and in higher doses could harm the neonate. The purpose of this study was to compare three doses of sufentanil combined with low-dose bupivacaine, to determine the lowest appropriate dose.

METHOD

In a prospective, randomized, double-blind study, 243 parturients were randomized, to receive A--0.5 microg/ml, or B--0.75 microg/ml or C--1 microg/ml sufentanil, in addition to bupivacaine 0.625 mg/ml+adrenaline 1.25 microg/ml. All were given an 8 ml bolus of the study solution, followed by continuous infusion at 6 ml/h. The analgetic effect was scored on a visual analogue scale (VAS). Onset quality was measured as VAS after 20 min, the total effect as VAS maximum during the first stage of labour. Overall maternal satisfaction was recorded within two hours post partum. Side effects were noted.

RESULTS

There were no differences between groups in VAS assessments after 20 min or in maximum registered VAS. In group A, 83% had VAS 0-4 after 20 min, in group B 77% and in group C 71%. Maximum VAS during the first stage was 0-4 for 60% of group A, 68% of group B and 61% of group C. Maternal satisfaction was also the same in the three groups. In group A, 70% reported excellent effect and 22% good effect. The corresponding figures in group B were 68% and 24% respectively, and in group C 62% and 24% respectively. Group A received a mean total dose of 21 microg sufentanil, group B 30 microg and group C 44 microg. Pruritus occurred in 51% of group A, 53% of group B and 65% of group C.

CONCLUSION

We found no difference in the analgesic effect between three different concentrations of sufentanil. We conclude that the lowest dose may be used. This should decrease the risk of adverse effects on mother and child.

背景

在分娩硬膜外镇痛中，舒芬太尼现在常被添加到局部麻醉剂中。然而，这种阿片类药物有一些副作用，如瘙痒，且高剂量时可能会对新生儿造成伤害。本研究的目的是比较三种剂量的舒芬太尼与低剂量布比卡因联合使用的效果，以确定最低合适剂量。

方法

在一项前瞻性、随机、双盲研究中，243名产妇被随机分组，除了接受0.625mg/ml布比卡因+1.25μg/ml肾上腺素外，分别接受A组——0.5μg/ml、B组——0.75μg/ml或C组——1μg/ml舒芬太尼。所有产妇均给予8ml研究溶液推注，然后以6ml/h持续输注。镇痛效果采用视觉模拟评分法（VAS）进行评分。起效质量以20分钟后的VAS测量，总效果以第一产程中VAS最大值测量。产后两小时内记录产妇总体满意度。记录副作用。

结果

20分钟后VAS评估或最大记录VAS在各组之间无差异。A组中，20分钟后83%的产妇VAS为0 - 4，B组为77%，C组为71%。第一产程中最大VAS为0 - 4的产妇，A组占60%，B组占68%，C组占61%。三组产妇的满意度也相同。A组中，70%报告效果极佳，22%报告效果良好。B组相应数字分别为68%和24%，C组分别为62%和24%。A组舒芬太尼平均总剂量为21μg，B组为30μg，C组为44μg。A组51%出现瘙痒，B组53%，C组65%。