Leo S, Lim Y, Sia A T H
Department of Women's Anaesthesia, Kandang Kerbau Women's and Children's Hospital, Singapore.
Anaesth Intensive Care. 2008 Sep;36(5):701-6. doi: 10.1177/0310057X0803600512.
Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. All epidural catheters were inserted by senior obstetric anaesthetists using a combined spinal epidural technique. The following information was recorded: parturients' demographic data, loss of resistance technique used, type and amount of local anaesthetic solution administered, complications encountered during procedure, pre-block and post-block pain scores, incidence of breakthrough pain requiring supplemental medication and post-block side-effects. Data from 2848 patients were collected and analysed; 56% of patients made up the saline group and 44% the air group. Patients in both groups had similar demographic profiles and similar incidences of complications and post-block side-effects. However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.
硬膜外间隙的识别通常采用对空气或生理盐水的阻力消失技术。我们试图研究所使用的介质是否会影响接受分娩硬膜外镇痛的产妇所获得的镇痛质量。我们对2003年5月至2005年3月在我们机构对初产妇进行的分娩硬膜外镇痛进行了回顾性审计。所有硬膜外导管均由资深产科麻醉师采用联合脊髓硬膜外技术插入。记录了以下信息：产妇的人口统计学数据、所使用的阻力消失技术、局部麻醉溶液的类型和用量、操作过程中遇到的并发症、阻滞前和阻滞后的疼痛评分、需要补充药物的突破性疼痛的发生率以及阻滞后的副作用。收集并分析了2848例患者的数据；56%的患者组成生理盐水组，44%的患者组成空气组。两组患者的人口统计学特征、并发症发生率和阻滞后副作用发生率相似。然而，空气组患者复发性突破性疼痛的发生率较高（P = 0.023）。我们还确定了与复发性突破性疼痛发生率增加相关的其他三个因素；阻滞前使用缩宫素、产妇在操作过程中的坐姿以及使用鞘内布比卡因诱导镇痛。我们的研究结果表明，与对生理盐水的阻力消失相比，对空气的阻力消失与接受联合脊髓硬膜外分娩镇痛的产妇复发性突破性疼痛的发生率较高有关。
