Gogarten W, Van Aken H
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster.
Zentralbl Gynakol. 2005 Dec;127(6):361-7. doi: 10.1055/s-2005-872477.
Epidural analgesia for labour has been associated with an increased rate of motor blockade, and instrumental and Caesarean deliveries. In recent years, these risks were significantly reduced with modern concepts of epidural analgesia, including the use of lower doses of local anaesthetics in combination with opioids. With combinations of 0.0625-0.125 % of bupivacaine plus sufentanil or fentanyl, the incidence of maternal motor blockade approximates 10 % and most parturients are nowadays able to ambulate during labour. Methods of epidural drug administration consist of intermittent boluses, patient-controlled epidural analgesia (PCEA) or continuous infusions. While intermittent top-ups and PCEA do not differ in the amount of local anaesthetics used, continuous infusions have been associated with increases in drug consumption and motor blockade in addition to a higher workload (e. g. frequent adjustments of infusion rates). They therefore do not appear to confer significant benefits during labour analgesia. The most common type of anaesthesia for Caesarean delivery is spinal anaesthesia due to its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an urgent or emergent Caesarean delivery. General anaesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuraxial blockade is contraindicated.
分娩时的硬膜外镇痛与运动阻滞发生率增加、器械助产和剖宫产率升高有关。近年来，随着现代硬膜外镇痛理念的出现，包括使用低剂量局麻药联合阿片类药物，这些风险显著降低。使用0.0625 - 0.125%的布比卡因联合舒芬太尼或芬太尼时，产妇运动阻滞的发生率约为10%，如今大多数产妇在分娩过程中能够行走。硬膜外给药方法包括间断推注、患者自控硬膜外镇痛（PCEA）或持续输注。虽然间断追加剂量和PCEA在局麻药使用量上没有差异，但持续输注除了工作量更大（如频繁调整输注速率）外，还与药物消耗量增加和运动阻滞有关。因此，在分娩镇痛期间，持续输注似乎并没有带来显著益处。剖宫产最常见的麻醉方式是脊麻，因为其操作简单、性价比高且起效快。它适用于紧急剖宫产病例。全身麻醉仍会导致较高的产妇死亡率，应仅用于绝对紧急情况和禁忌使用椎管内阻滞的病例。
