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[不同剂量鞘内注射吗啡联合罗哌卡因在腰麻-硬膜外联合分娩镇痛技术中的作用]

[The effects of various doses of intrathecal morphine in addition with ropivacaine in combined spinal-epidural technique for labour analgesia].

作者信息

Culha Hamdiye Tutan, Ozdamar Dilek, Toker Kamil, Solak Mine

机构信息

Department of Anaesthesiology and Reanimation, Kocaeli University, Medical Faculty, Kocaeli, Turkey.

出版信息

Agri. 2007 Oct;19(4):16-23.

Abstract

We evaluated the duration of analgesia, side effects and neonatal effects of intrathecal ropivacaine combined with two different doses of morphine using combined spinal epidural (CSE) technique for labour analgesia. Fourty term parturients were enrolled. Group I received 0,2% ropivacaine 3 mg + morphine 50 microg and Group II received 0,2% ropivacaine 3 mg + morphine 100 microg intrathecally. When VAS for pain was equal or above 30 mm, PCEA(Patient controlling epidural analgesia) was started using 0,1% ropivacaine. There wasn't any statistical significant difference considering the duration of analgesia between two groups. The first stage of labour was significantly shorter in Group II then Group I, and the epidural local anaesthetic volume was significantly lower in Group II. The most common side effect in both groups was pruritus. There was not any side effect of local anaesthetic and opioid on the newborns. Adequate analgesia was obtained during labour with CSE technique, using ropivacaine combined with 50 and 100 microg morphine intrathecally. However cervical dilatation was faster and epidural local anaesthetic volume was lower in the group in which 100 microg morphine was used. Also considering the unchanged incidence of the side effects, 3 mg 0,2% ropivacaine + 100 microg morphine may be a useful combination for labour analgesia.

摘要

我们采用联合腰麻硬膜外麻醉(CSE)技术,评估鞘内注射罗哌卡因联合两种不同剂量吗啡用于分娩镇痛时的镇痛持续时间、副作用及对新生儿的影响。纳入40名足月产妇。I组鞘内注射0.2%罗哌卡因3mg+吗啡50μg,II组鞘内注射0.2%罗哌卡因3mg+吗啡100μg。当疼痛视觉模拟评分(VAS)等于或高于30mm时,开始使用0.1%罗哌卡因进行患者自控硬膜外镇痛(PCEA)。两组间镇痛持续时间无统计学显著差异。II组第一产程明显短于I组,且II组硬膜外局部麻醉药用量明显更低。两组最常见的副作用是瘙痒。局部麻醉药和阿片类药物对新生儿均无任何副作用。采用CSE技术,鞘内注射罗哌卡因联合50μg和100μg吗啡可在分娩期间获得充分镇痛。然而,使用100μg吗啡的组宫颈扩张更快,硬膜外局部麻醉药用量更低。此外,考虑到副作用发生率未变,0.2%罗哌卡因3mg+100μg吗啡可能是一种有效的分娩镇痛组合。

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