Milaszkiewicz R, Payne N, Loughnan B, Blackett A, Barber N, Carli F
Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex.
Anaesthesia. 1992 Dec;47(12):1042-6. doi: 10.1111/j.1365-2044.1992.tb04198.x.
We studied 86 primiparous women with uncomplicated pregnancy and labour requesting extradural analgesia in labour. All the women were over 36 weeks of gestation with a cephalic-presenting singleton fetus. The women were allocated randomly to two groups: group A, who received an extradural infusion of lignocaine 0.75%, after an initial dose of 10 ml of lignocaine 1.5%, and group B, who received an infusion of bupivacaine 0.125% after an initial dose of 10 ml of bupivacaine 0.25%. All the women had their labour actively managed. Assessment of analgesia during labour and delivery, and the requirements for additional top-ups were noted, as were mode of delivery, requirement for oxytocic augmentation and incidence of fetal distress. Maternal and umbilical cord plasma concentrations of lignocaine were measured at delivery in 12 women receiving extradural lignocaine. There were no statistically significant differences between the two groups in terms of the mode of delivery, incidence of fetal distress, fetal heart rate abnormalities, or Apgar scores of the babies. Women in the bupivacaine group had a significantly better quality of analgesia during both the first and second stages of labour (p = 0.0005) and required fewer top-ups than those in the lignocaine group. However, the requirement for oxytocin augmentation during the first and second stages of labour was significantly less in the lignocaine group (p = 0.004). Similarly, the duration of the second stage was shorter compared with the bupivacaine group. In spite of high plasma concentrations of lignocaine, no side effects were noted in either mothers or babies.
我们研究了86例单胎头位妊娠、分娩过程无并发症且要求分娩时硬膜外镇痛的初产妇。所有产妇均已孕36周以上。这些产妇被随机分为两组：A组在初始剂量10 ml 1.5%的利多卡因后接受0.75%利多卡因硬膜外输注；B组在初始剂量10 ml 0.25%的布比卡因后接受0.125%布比卡因输注。所有产妇的分娩均得到积极管理。记录了分娩过程中的镇痛评估、追加用药需求、分娩方式、催产素增加需求及胎儿窘迫发生率。对12例接受硬膜外利多卡因的产妇在分娩时测定了母体和脐带血浆中的利多卡因浓度。两组在分娩方式、胎儿窘迫发生率、胎儿心率异常或婴儿阿氏评分方面无统计学显著差异。布比卡因组产妇在第一产程和第二产程的镇痛质量均显著更好（p = 0.0005），且追加用药次数少于利多卡因组。然而，利多卡因组在第一产程和第二产程中催产素增加需求显著更少（p = 0.004）。同样，与布比卡因组相比，第二产程持续时间更短。尽管母体血浆利多卡因浓度较高，但未观察到母亲或婴儿出现副作用。
