Ross Vernon H, Moore Charles H, Pan Peter H, Fragneto Regina Y, James Robert L, Justis Gina B
*Department of Anesthesiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia; the †Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; the ‡University of Kentucky College of Medicine, Lexington, Kentucky.
Anesth Analg. 2003 Nov;97(5):1504-1508. doi: 10.1213/01.ANE.0000083372.87670.09.
On the basis of our previous clinical experience, we hypothesized in this study that the duration and/or quality of labor analgesia produced by intrathecal sufentanil was less in cocaine-abusing parturients compared with nonabusing parturients. Ten micro g of sufentanil was given intrathecally as part of a combined spinal-epidural (CSE) technique to two groups of laboring parturients: 1). those whose urine tested positive for cocaine (cocaine group), and 2). those whose urine tested negative for cocaine (control group). The epidural catheter was not injected with local anesthetic until the patient requested additional pain relief. The time from injection of intrathecal sufentanil until patient request for additional pain relief was defined as duration of analgesia. Baseline visual analog pain score (VAPS) and cervical dilation were measured before the CSE was performed. After injection of intrathecal sufentanil, VAPS was recorded at specific intervals. Cervical dilation was again documented when the patient requested additional analgesia. We found that both groups reported high baseline VAPS and a marked decrease in VAPS after injection of sufentanil that did not differ between groups. Geometric mean duration of pain relief with adjustment for cervical dilation was 87 min in the cocaine group compared with 139 min in the control group (P = 0.019). All patients experienced itching. We conclude that intrathecal sufentanil produces a similar quality but shorter duration of analgesia in cocaine-abusing parturients compared with nonabusing parturients.
Intrathecal sufentanil administered as part of a combined spinal-epidural technique produces similar quality but reduced duration of labor analgesia in cocaine-abusing parturients compared with nonabusing parturients.
基于我们之前的临床经验，我们在本研究中假设，与未滥用可卡因的产妇相比，鞘内注射舒芬太尼对滥用可卡因的产妇产生的分娩镇痛持续时间和/或质量较短。将10微克舒芬太尼作为腰麻-硬膜外联合（CSE）技术的一部分鞘内注射给两组分娩产妇：1）尿液可卡因检测呈阳性的产妇（可卡因组），以及2）尿液可卡因检测呈阴性的产妇（对照组）。直到患者要求额外的疼痛缓解时，才向硬膜外导管注射局部麻醉剂。从鞘内注射舒芬太尼到患者要求额外疼痛缓解的时间定义为镇痛持续时间。在进行CSE之前测量基线视觉模拟疼痛评分（VAPS）和宫颈扩张情况。鞘内注射舒芬太尼后，在特定时间间隔记录VAPS。当患者要求额外镇痛时，再次记录宫颈扩张情况。我们发现两组产妇的基线VAPS都很高，注射舒芬太尼后VAPS均显著下降，两组之间无差异。校正宫颈扩张后的疼痛缓解几何平均持续时间，可卡因组为87分钟，而对照组为139分钟（P = 0.019）。所有患者均出现瘙痒。我们得出结论，与未滥用可卡因的产妇相比，鞘内注射舒芬太尼对滥用可卡因的产妇产生的镇痛质量相似，但持续时间较短。
作为腰麻-硬膜外联合技术的一部分给予鞘内舒芬太尼时，与未滥用可卡因的产妇相比，滥用可卡因的产妇分娩镇痛质量相似，但持续时间缩短。
