Lim Yvonne, Ocampo Cecilia E, Supandji Mia, Teoh Wendy H L, Sia Alex T
Department of Woman Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore 229899.
Anesth Analg. 2008 Dec;107(6):1968-72. doi: 10.1213/ane.0b013e3181887ffb.
Patient-controlled epidural analgesia (PCEA) is a safe and effective mode of maintaining labor analgesia; however, the ideal PCEA regimen is controversial.
In this prospective, randomized, double-blind study, we examined the analgesic efficacy of demand-only PCEA and PCEA with background infusion. We recruited 300 nulliparous parturients. Analgesia was initiated with intrathecal ropivacaine 2 mg and fentanyl 15 microg and maintained with epidural ropivacaine 0.1% with fentanyl 2 microg/mL. Parturients were randomized to one of three groups. Group 0: demand-only PCEA, bolus of 5 mL, lockout interval of 15 min. Group 5: background infusion of 5 mL/h, bolus of 5 mL, lockout interval of 12 min. Group 10: background infusion of 10 mL/h, bolus of 5 mL, lockout interval of 10 min. The maximum dose of all groups was 20 mL/h. The primary outcome was incidence of breakthrough pain. Secondary outcomes included intrapartum pain scores, neuraxial blockade characteristics, side effects, the total and hourly volume of ropivacaine, neonatal outcomes, and obstetric outcomes.
The incidence of breakthrough pain and the maximum visual analog scale (0-100 mm scale) pain scores were higher in Group 0 versus Groups 5 and 10 (43% vs 17% and 11%, P < 0.001 and 37 +/- 28 vs 22 +/- 26 and 16 +/- 25 [mean +/- SD], P < 0.001), respectively. Group 10 had a longer duration of effective analgesia compared with Group 0 (mean 895 min, 95% CI 823-966 vs 565 min, 95% CI 454-677, P < 0.001) and increased ropivacaine consumption, and was associated with a longer duration of the second stage of labor.
Demand-only PCEA (5-mL bolus, 15-min lockout interval) resulted in less local anesthetic consumption but an increased incidence of breakthrough pain, higher pain scores, shorter duration of effective analgesia, and lower maternal satisfaction, when compared with PCEA with background infusion (5-mL bolus, 10-12-min lockout interval, and 5-10 mL/h infusion).
患者自控硬膜外镇痛（PCEA）是维持分娩镇痛的一种安全有效的方式；然而，理想的PCEA方案仍存在争议。
在这项前瞻性、随机、双盲研究中，我们比较了单纯按需PCEA与背景输注PCEA的镇痛效果。我们招募了300例初产妇。镇痛起始采用鞘内注射罗哌卡因2mg和芬太尼15μg，并以含2μg/mL芬太尼的0.1%硬膜外罗哌卡因维持。产妇被随机分为三组。0组：单纯按需PCEA，单次推注量5mL，锁定时间15分钟。5组：背景输注速度5mL/h，单次推注量5mL，锁定时间12分钟。10组：背景输注速度10mL/h，单次推注量5mL，锁定时间10分钟。所有组的最大剂量均为20mL/h。主要结局为爆发痛的发生率。次要结局包括产时疼痛评分、神经阻滞特征、副作用、罗哌卡因的总量和每小时用量、新生儿结局及产科结局。
0组的爆发痛发生率和最大视觉模拟评分（0 - 100mm量表）疼痛评分高于5组和10组（分别为43%对17%和11%，P < 0.001；以及37±28对22±26和16±25[均值±标准差]，P < 0.001）。与0组相比，10组的有效镇痛持续时间更长（平均895分钟，95%置信区间823 - 966对565分钟，95%置信区间454 - 677，P < 0.001），罗哌卡因消耗量增加，且与第二产程持续时间延长有关。
与背景输注PCEA（单次推注量5mL，锁定时间10 - 12分钟，输注速度5 - 10mL/h）相比，单纯按需PCEA（单次推注量5mL，锁定时间15分钟）导致局部麻醉药消耗量减少，但爆发痛发生率增加、疼痛评分更高、有效镇痛持续时间更短且产妇满意度更低。
