Wilson Matthew J A, Cooper Griselda, MacArthur Christine, Shennan Andrew
Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK.
Anesthesiology. 2002 Dec;97(6):1567-75. doi: 10.1097/00000542-200212000-00032.
The authors recently showed that "mobile" epidural analgesia, using low-dose local anesthetic-opioid mixtures, reduces the impact of epidural analgesia on instrumental vaginal delivery, relative to a traditional technique. The main prespecified assessment of pain relief efficacy, women's postpartum estimates of labor pain after epidural insertion, did not differ. The detailed analgesic efficacy and the anesthetic characteristics of the techniques are reported here.
A total of 1,054 nulliparous women were randomized, in labor, to receive boluses of 10 ml 0.25% bupivacaine (traditional), combined spinal-epidural (CSE) analgesia, or low-dose infusion (LDI), the latter groups utilizing 0.1% bupivacaine with 2 microg/ml fentanyl. Visual analog scale pain assessments were collected throughout labor and delivery and 24 h later. Details of the conduct of epidural analgesia, drug utilization, and requirement for anesthesiologist reattendance were recorded.
A total of 353 women were randomized to receive traditional epidural analgesia, 351 received CSE, and 350 received LDI. CSE was associated with a more rapid onset of analgesia, lower median visual analog scale pain scores than traditional in the first hour after epidural insertion, and a significant reduction in bupivacaine dose given during labor. Pain scores reported by women receiving LDI were similar to those in the traditional group throughout labor and delivery. Anesthesiologist reattendance was low but greater with each mobile technique.
Relative to traditional epidural analgesia, LDI is at least as effective and CSE provided better pain relief in the early stages after insertion. The proven efficacy of mobile epidurals and their beneficial impact on delivery mode make them the preferred techniques for epidural pain relief in labor.
作者最近表明，相对于传统技术，使用低剂量局部麻醉药 - 阿片类药物混合物的“移动”硬膜外镇痛可减少硬膜外镇痛对器械助产阴道分娩的影响。预先设定的主要疼痛缓解效果评估，即硬膜外穿刺后置管后女性产后对分娩疼痛的估计，并无差异。本文报告了这些技术的详细镇痛效果和麻醉特性。
总共1054名未产妇在分娩时被随机分组，分别接受10毫升0.25%布比卡因推注（传统组）、腰麻 - 硬膜外联合（CSE）镇痛或低剂量输注（LDI），后两组使用0.1%布比卡因与2微克/毫升芬太尼。在整个分娩和产后24小时收集视觉模拟评分法疼痛评估数据。记录硬膜外镇痛的实施细节、药物使用情况以及麻醉医生再次到场的需求。
总共353名女性被随机分配接受传统硬膜外镇痛，351名接受CSE，350名接受LDI。CSE与镇痛起效更快相关，在硬膜外穿刺后置管后的第一小时，其视觉模拟评分法疼痛中位数低于传统组，并且分娩期间给予的布比卡因剂量显著减少。接受LDI的女性在整个分娩和产程中的疼痛评分与传统组相似。麻醉医生再次到场的情况较少，但每种移动技术组的再次到场情况更多。
相对于传统硬膜外镇痛，LDI至少同样有效，CSE在置管后的早期阶段提供了更好的疼痛缓解。移动硬膜外镇痛已证实的疗效及其对分娩方式的有益影响使其成为分娩时硬膜外镇痛的首选技术。
