Malhotra S, Yentis S M
Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fullham Road, London SW10 9NH, UK.
Anaesthesia. 2007 Jul;62(7):667-71. doi: 10.1111/j.1365-2044.2007.05096.x.
Women in labour receiving epidural analgesia with 15 ml bupivacaine 0.1% and 2 microg.ml(-1) fentanyl followed by 10-15-ml top-ups as required, who needed Caesarean section, were randomly allocated to receive 20 ml levobupivacaine 0.5% over 3 min with either 75 microg fentanyl (1.5 ml) or 1.5 ml saline. Further top-ups or inhaled or intravenous supplementation were given for breakthrough pain. Time to onset (loss of cold sensation to T4 and touch sensation to T5 bilaterally), quality of analgesia and side-effects were recorded. The study was stopped after 112 patients had been randomly assigned, due to a unit protocol change, from midwife-administered top-ups to patient-controlled epidural analgesia. Data from 51 patients given fentanyl and 54 given saline were available for analysis. There were no significant differences in onset times or supplementation between the groups, but there was more intra-operative nausea/vomiting with fentanyl (53%) than with saline (18%; p = 0.004). We found no advantage of adding fentanyl to epidural levobupivacaine when extending epidural analgesia in women already receiving epidural fentanyl during labour and there was an increased incidence of intra-operative nausea and vomiting. Power analysis suggested the same conclusion even had the study proceeded to completion.
正在接受硬膜外镇痛的产妇，使用15毫升0.1%布比卡因和2微克/毫升芬太尼，必要时追加10 - 15毫升，这些需要剖宫产的产妇被随机分配，在3分钟内接受20毫升0.5%左旋布比卡因，同时分别给予75微克芬太尼（1.5毫升）或1.5毫升生理盐水。对于突破性疼痛，给予进一步追加药物或吸入或静脉补充药物。记录起效时间（双侧T4感觉冷觉丧失和T5触觉丧失）、镇痛质量和副作用。由于单位方案变更，从助产士给药追加改为患者自控硬膜外镇痛，在112例患者被随机分配后，该研究停止。有51例接受芬太尼和54例接受生理盐水的患者数据可供分析。两组之间在起效时间或补充药物方面无显著差异，但芬太尼组术中恶心/呕吐发生率（53%）高于生理盐水组（18%；p = 0.004）。我们发现，对于在分娩期间已接受硬膜外芬太尼的女性延长硬膜外镇痛时，在硬膜外左旋布比卡因中添加芬太尼并无优势，且术中恶心和呕吐发生率增加。功效分析表明，即使该研究继续进行至完成，也会得出相同结论。
