Bolukbasi D, Sener E B, Sarihasan B, Kocamanoglu S, Tur A
Department of Anesthesiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey.
Int J Obstet Anesth. 2005 Oct;14(4):288-93. doi: 10.1016/j.ijoa.2005.04.007.
Several studies have been performed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus. We aimed to compare the efficacy and side effects of epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl at low concentrations.
Forty ASA I-II parturients' were included in this prospective, double-blind, trial and randomized to receive either bupivacaine or ropivacaine for labor analgesia. Analgesia was initiated with 8 mL of 0.125% solution plus fentanyl 50 microg and maintained with a continuous infusion of 0.0625% solution with fentanyl 2 microg/mL.
There were no differences in pain scores, total dose of local anesthetics used, sensory or motor blockade, labor duration, mode of delivery, side effects, patient satisfaction, or neonatal outcome between the two local anesthetics at these dosages, but at the end of the second stage and delivery, adequate analgesia quality could not be ensured.
We found no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.
已经进行了多项研究，以寻找一种对母亲和胎儿副作用及毒性最小的安全分娩镇痛方法。我们旨在比较低浓度硬膜外布比卡因加芬太尼和罗哌卡因加芬太尼的疗效和副作用。
40例美国麻醉医师协会（ASA）分级为I-II级的产妇被纳入这项前瞻性、双盲试验，并随机分为接受布比卡因或罗哌卡因进行分娩镇痛。镇痛起始剂量为8毫升0.125%溶液加芬太尼50微克，并以0.0625%溶液加芬太尼2微克/毫升持续输注维持。
在这些剂量下，两种局部麻醉药在疼痛评分、局部麻醉药总用量、感觉或运动阻滞、产程、分娩方式、副作用、患者满意度或新生儿结局方面均无差异，但在第二产程结束和分娩时，无法确保足够的镇痛质量。
我们发现，对于分娩镇痛，持续硬膜外输注0.0625%罗哌卡因加2微克/毫升芬太尼并不比0.0625%布比卡因加2微克/毫升芬太尼有明显优势。我们认为，可以尝试不同的方法或剂量，以提高第二产程和分娩时的舒适度。
