Bucklin Brenda A, Chestnut David H, Hawkins Joy L
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska 98198-4455, USA.
Reg Anesth Pain Med. 2002 Jan-Feb;27(1):23-30. doi: 10.1053/rapm.2002.29111.
Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women.
Relevant clinical studies were identified using electronic and manual searches of the literature covering the period from 1989 to 2000. Searches used the following descriptors: intrathecal analgesia, spinal opioids, epidural analgesia, epidural local anesthetics, and analgesia for labor. Data were extracted from 7 randomized clinical trials comparing analgesic measures, incidence of motor block, pruritus, nausea, hypotension, mode of delivery, and/or Apgar scores.
Combined test results indicated comparable analgesic efficacy 15 to 20 minutes after injection with single-injection intrathecal opioid administration. Intrathecal opioid injections were associated with a greater incidence of pruritus (odds ratio, 14.01; 99% confidence interval, 6.9 to 28.3), but there was no difference in the incidence of nausea or in the method of delivery.
Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.
一些麻醉医生认为，分娩期间鞘内注射阿片类药物比传统硬膜外技术具有优势。比较单次鞘内注射阿片类药物与硬膜外局部麻醉药的镇痛效果及产科结局的随机临床试验表明，鞘内注射阿片类药物能提供相当的镇痛效果，且严重副作用较少。本荟萃分析比较了单次鞘内注射阿片类药物技术与硬膜外局部麻醉药在分娩女性中的镇痛效果、副作用及产科结局。
通过电子和手工检索1989年至2000年期间的文献来确定相关临床研究。检索使用了以下描述词：鞘内镇痛、脊髓阿片类药物、硬膜外镇痛、硬膜外局部麻醉药及分娩镇痛。从7项比较镇痛措施、运动阻滞发生率、瘙痒、恶心、低血压、分娩方式和/或阿氏评分的随机临床试验中提取数据。
综合测试结果表明，单次鞘内注射阿片类药物后15至20分钟，镇痛效果相当。鞘内注射阿片类药物与瘙痒发生率较高相关（优势比，14.01；99%置信区间，6.9至28.3），但恶心发生率或分娩方式无差异。
已发表的研究表明，与硬膜外局部麻醉药相比，鞘内注射阿片类药物在分娩早期提供的镇痛效果相当。鞘内注射阿片类药物会导致瘙痒发生率更高。技术选择似乎不影响分娩方式。
