Boselli Emmanuel, Debon Richard, Cimino Yann, Rimmelé Thomas, Allaouchiche Bernard, Chassard Dominique
Service d'Anesthésie-Réanimation, Hôtel-Dieu, Lyon, France.
Anesthesiology. 2004 Apr;100(4):968-72. doi: 10.1097/00000542-200404000-00030.
Although patient-controlled epidural analgesia (PCEA) during labor has been extensively studied in recent clinical trials, the role of a background infusion associated with self-administered boluses is still debated. The authors designed a study to assess whether the use of PCEA with or without background infusion could improve the comfort of parturients and their satisfaction during labor and delivery without affecting the total consumption of local anesthetics.
One hundred thirty-three laboring parturients requesting epidural analgesia administered via PCEA with a solution of 0.1% ropivacaine plus 0.5 microg/ml sufentanil were randomly assigned to four groups, according to the rate of background infusion used (0, 3, 6, and 9 ml/h). Local anesthetic requirements, maternal satisfaction, verbal pain scores, incidence of side effects, and outcome of labor were compared among groups.
Patient demographics, labor characteristics, side effects, and Apgar scores were similar in each group. No significant differences were observed between groups in verbal pain scores during labor, number of supplemental boluses, or maternal satisfaction. A significantly greater overall total drug consumption with a 6-ml/h or a 9-ml/h background infusion (74 and 78 ml, respectively) was observed in comparison with PCEA without a background infusion (55 ml). A similar relation was observed for hourly use during both the first and the second stage of labor.
The results of this study suggest that the use of a background infusion with PCEA during labor leads to a greater consumption of anesthetic solution without improving comfort and satisfaction of parturients. Moreover, not using a background infusion does not provide an increased incidence of supplemental boluses (which might cause problems in a busy unit) and allows for a substantial reduction in the cost of analgesia.
尽管近期临床试验对分娩期间患者自控硬膜外镇痛（PCEA）进行了广泛研究，但与患者自控推注联合使用的背景输注的作用仍存在争议。作者设计了一项研究，以评估使用或不使用背景输注的PCEA是否能在不影响局部麻醉药总消耗量的情况下，提高产妇在分娩和分娩期间的舒适度及其满意度。
133名要求通过PCEA使用0.1%罗哌卡因加0.5微克/毫升舒芬太尼溶液进行硬膜外镇痛的分娩产妇，根据背景输注速率（0、3、6和9毫升/小时）随机分为四组。比较各组之间局部麻醉药需求量、产妇满意度、言语疼痛评分、副作用发生率和分娩结局。
各组患者的人口统计学特征、分娩特征、副作用和阿氏评分相似。各组之间在分娩期间的言语疼痛评分、追加推注次数或产妇满意度方面未观察到显著差异。与无背景输注的PCEA（55毫升）相比，背景输注速率为6毫升/小时或9毫升/小时时，总体总药物消耗量显著更高（分别为74毫升和78毫升）。在分娩的第一阶段和第二阶段，每小时使用量也观察到类似关系。
本研究结果表明，分娩期间使用PCEA联合背景输注会导致麻醉药溶液消耗量增加，而不会提高产妇的舒适度和满意度。此外，不使用背景输注不会增加追加推注的发生率（这可能在繁忙的科室中引发问题），并可大幅降低镇痛成本。
