Sullivan J T, Grobman W A, Bauchat J R, Scavone B M, Grouper S, McCarthy R J, Wong C A
Departments of Anesthesiology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 251 E. Huron Street, F5-704, Chicago, IL 60611, USA.
Int J Obstet Anesth. 2009 Oct;18(4):328-34. doi: 10.1016/j.ijoa.2009.02.006. Epub 2009 Aug 13.
Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia.
Parturients with singleton breech presentation (n=96) were randomized to receive CSE analgesia with bupivacaine 2.5mg and fentanyl 15 microg (CSE group) or intravenous fentanyl 50 microg (SYS group) before ECV attempt. The primary outcome was ECV success.
The success rate of ECV was 47% with CSE and 31% in the SYS group (P=0.14). Subsequent vaginal delivery was 36% for CSE and 25% for SYS (P=0.27). Median [IQR] visual analog pain scores (0-100mm scale) were lower with CSE (3 [0-12]) compared to SYS analgesia (36 [16 to 54]) (P<0.005) and patient satisfaction (0-10 scale) was higher (CSE 10 [9 to 10] versus SYS 7 [4 to 9]) (P<0.005). There were no differences in fetal heart rate patterns, but median time to return to fetal heart rate reactivity after analgesia was shorter with CSE (13 [IQR 9-21] min) compared to the SYS group (39 [IQR 23-51] min) (P=0.02).
There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.
提高臀位外倒转术（ECV）的成功率可能有助于避免一些剖宫产。与对照组相比，比较ECV联合神经轴索镇痛成功率的随机试验结果并不一致。我们假设与全身阿片类镇痛相比，腰麻-硬膜外联合（CSE）镇痛会提高ECV的成功率。
将单胎臀位产妇（n = 96）随机分为两组，在尝试ECV前，一组接受含2.5mg布比卡因和15μg芬太尼的CSE镇痛（CSE组），另一组接受静脉注射50μg芬太尼（SYS组）。主要结局是ECV成功。
CSE组ECV成功率为47%，SYS组为31%（P = 0.14）。CSE组随后经阴道分娩率为36%，SYS组为25%（P = 0.27）。与SYS镇痛相比，CSE组视觉模拟疼痛评分中位数[四分位间距]（0 - 100mm量表）更低（3 [0 - 12]）（P < 0.005），患者满意度（0 - 10量表）更高（CSE组10 [9 - 10] 对比SYS组7 [4 - 9]）（P < 0.005）。胎儿心率模式无差异，但与SYS组相比，CSE组镇痛后恢复胎儿心率反应性的中位时间更短（13 [四分位间距9 - 21]分钟）（P = 0.02）。
与静脉注射芬太尼镇痛相比，CSE用于ECV成功或经阴道分娩率无差异。CSE镇痛时疼痛评分更低，满意度更高，且CSE组胎儿心率反应性的中位时间更短。
