Orlikowski Christopher E P, Dickinson Jan E, Paech Michael J, McDonald Susan J, Nathan Elizabeth
Staff Specialist Anaesthetist, Royal Hobart Hospital, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2006 Oct;46(5):395-401. doi: 10.1111/j.1479-828X.2006.00624.x.
The effect of intrapartum analgesia on post-partum maternal back and neck pain, headache and migraine, is uncertain.
To determine if nulliparous women having epidural analgesia during labour have a similar incidence of the above-mentioned post-partum symptoms compared with women managed using other forms of pain relief.
Secondary analysis of cohort data from a randomised trial in which nulliparous women intending to deliver vaginally were randomised to either epidural analgesia (EPI) or continuous midwifery support (CMS) at admission for delivery. Because of high cross-over rates, groups were initially defined by the randomised treatment allocation and the actual treatment received (CMS-CMS n = 185, EPI-CMS n = 117, EPI-EPI n = 376 and CMS-EPI n = 314). Univariate analysis showed no difference between groups, so final analysis was based on the actual treatment received.
Six hundred and ninety women received epidural analgesia (EPIDURAL) and 302 received other methods of pain relief including CMS. Back pain was common before, during and after pregnancy, and risk factors for post-partum back pain at six months were back pain prior to pregnancy or at two months post-partum. Epidural analgesia, mode of delivery, spontaneous or induced labour, birthweight and back pain during pregnancy had no significant relationship with post-partum back pain at six months. Headache was significantly more common in the EPIDURAL group during pregnancy and at two months post-partum, but not at six months. Migraine was not associated with intrapartum analgesia.
This analysis supports previous research suggesting that epidural analgesia is not a significant risk factor for persisting post-partum back pain, headache or migraine.
产时镇痛对产后产妇背部和颈部疼痛、头痛及偏头痛的影响尚不确定。
确定与采用其他镇痛方式的产妇相比，分娩期间接受硬膜外镇痛的初产妇出现上述产后症状的发生率是否相似。
对一项随机试验的队列数据进行二次分析，该试验中，计划经阴道分娩的初产妇在入院分娩时被随机分为硬膜外镇痛组（EPI）或持续助产支持组（CMS）。由于交叉率较高，最初根据随机分配的治疗方案和实际接受的治疗来定义分组（CMS-CMS组n = 185，EPI-CMS组n = 117，EPI-EPI组n = 376，CMS-EPI组n = 314）。单因素分析显示各组之间无差异，因此最终分析基于实际接受的治疗。
690名妇女接受了硬膜外镇痛（EPIDURAL），302名接受了包括CMS在内的其他镇痛方法。背痛在怀孕前、孕期及产后都很常见，产后6个月背痛的危险因素是怀孕前或产后2个月时的背痛。硬膜外镇痛、分娩方式、自然分娩或引产、出生体重以及孕期背痛与产后6个月的背痛均无显著关系。头痛在孕期及产后2个月时在硬膜外镇痛组中显著更常见，但在产后6个月时并非如此。偏头痛与产时镇痛无关。
该分析支持先前的研究，表明硬膜外镇痛不是产后持续性背痛、头痛或偏头痛的重要危险因素。
