Viitanen H, Viitanen M, Heikkilä M
Department of Anaesthesiology, Central Hospital of Seinajoki, Seinajoka, Finland.
Acta Anaesthesiol Scand. 2005 Aug;49(7):1023-9. doi: 10.1111/j.1399-6576.2005.00803.x.
Intrathecal analgesia (ITA) is effective in late, rapidly progressing labour. In 1998, our hospital implemented the use of single-shot spinal block for pain relief in multiparous parturients. As part of a quality assurance programme, we assessed the analgesic efficacy, obstetric and neonatal outcomes and maternal satisfaction after this form of analgesia now in routine use in our labour ward.
Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting analgesia were asked to participate in this prospective study. All parturients received our standard ITA: 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) inserted via the L2-3 or L3-4 interspace. Routine monitoring included maternal vital signs, uterine contraction and fetal heart rate tracing. Pain scores (visual analogue scale (VAS) 0-10), sensory levels, motor block, side-effects and maternal satisfaction were recorded. Satisfactory analgesia was defined as a decrease in pain scores to three or less within 20 min after injection. The number of parturients requesting additional analgesia and the duration of spinal block (time from injection until request for additional medication after satisfactory analgesia had worn off) were recorded.
Two hundred and nine parturients were included in the study. Satisfactory analgesia was achieved in 153 (73%) parturients. Fifty-five (26%) women requested additional analgesia: 38 (18%) because of unsatisfactory analgesia and 17 (8%) because analgesia ended before delivery. The duration of spinal block was 101 +/- 34 min. Pruritus occurred in 64%, fetal bradycardia in 7% and hypotension in 2% of deliveries. Pain relief was rated excellent by 65%, moderate by 20% and inadequate by 14% of the parturients. One hundred and sixty-nine (81%) women stated that they would like to have spinal analgesia again for pain relief during delivery.
The majority of multiparous parturients found ITA adequate for pain relief during delivery. However, modifications are required in terms of improved timing, reliability and duration of analgesia.
鞘内镇痛（ITA）在晚期、进展迅速的分娩中有效。1998年，我院开始对经产妇使用单次脊麻进行镇痛。作为质量保证计划的一部分，我们评估了这种目前在产房常规使用的镇痛方式的镇痛效果、产科及新生儿结局以及产妇满意度。
连续229例经产妇前来阴道分娩并要求镇痛，被邀请参加这项前瞻性研究。所有产妇均接受我们的标准ITA：通过L2 - 3或L3 - 4椎间隙注入2.5mg布比卡因（1ml） + 25μg芬太尼（0.5ml）。常规监测包括产妇生命体征、子宫收缩及胎心监护。记录疼痛评分（视觉模拟评分法（VAS）0 - 10分）、感觉平面、运动阻滞、副作用及产妇满意度。满意镇痛定义为注射后20分钟内疼痛评分降至3分或更低。记录要求追加镇痛的产妇人数及脊麻持续时间（从注射至满意镇痛效果消失后要求追加药物的时间）。
209例产妇纳入研究。153例（73%）产妇获得满意镇痛。55例（26%）产妇要求追加镇痛：38例（18%）是因为镇痛效果不满意，17例（8%）是因为镇痛在分娩前结束。脊麻持续时间为101±34分钟。64%的分娩出现瘙痒，7%出现胎儿心动过缓，2%出现低血压。65%的产妇将疼痛缓解评为优，20%评为中，14%评为差。169例（81%）产妇表示愿意在下次分娩时再次接受脊麻镇痛。
大多数经产妇认为ITA足以缓解分娩时的疼痛。然而，在镇痛的时机、可靠性及持续时间方面仍需改进。
