分娩期间的“超轻量”患者自控硬膜外镇痛：不同方案对镇痛效果和医生工作量的影响

"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.

作者信息

Carvalho B, Cohen S E, Giarrusso K, Durbin M, Riley E T, Lipman S

机构信息

Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.

出版信息

Int J Obstet Anesth. 2005 Jul;14(3):223-9. doi: 10.1016/j.ijoa.2005.02.003.

DOI:10.1016/j.ijoa.2005.02.003

PMID:15935646

Abstract

BACKGROUND

Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia.

METHODS

Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (n=30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625% + sufentanil 0.35 microg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout.

RESULTS

In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%.

CONCLUSIONS

These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.

摘要

背景

与持续硬膜外输注用于维持分娩镇痛相比，患者自控硬膜外镇痛（PCEA）具有许多优势。其中一些益处可能取决于PCEA的设置。本研究评估了几种“超轻量”（0.125%）PCEA联合基础持续输注（CI）用于分娩镇痛的方案，目标是在提供良好镇痛效果的同时尽量减少医生的干预。

方法

220名在活跃期分娩（宫颈扩张<5cm）时接受硬膜外镇痛的ASA I-II级女性被双盲随机分为四个治疗组（每组n = 30）。使用0.0625%布比卡因+0.35μg/mL舒芬太尼通过PCEA/CI泵维持镇痛。PCEA设置为：A组：CI 10 mL/h，PCEA单次剂量6 mL，锁定时间8分钟；B组：CI 10 mL/h，PCEA单次剂量12 mL，锁定时间16分钟；C组：CI 15 mL/h，PCEA单次剂量6 mL，锁定时间8分钟；D组：CI 15 mL/h，PCEA单次剂量12 mL，锁定时间16分钟。