Sołek-Pastuszka Joanna, Kepiński Stanisław, Makowski Arystarch, Celewicz Zbigniew, Zukowski Maciej, Safranow Krzysztof, Bohatyrewicz Romuald
Klinika Anestezjologii i Intensywnej Terapii, Pomorska AM w Szczecinie.
Anestezjol Intens Ter. 2009 Apr-Jun;41(2):84-8.
Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil. Encouraged by positive reports, we compared the efficacy of patient-controlled remifentanil infusion (PCA) with patient-controlled continuous epidural analgesia (PCEA).
Fifty-two ASA I and II parturients were arbitrarily allocated, without randomisation, to two groups to receive PCEA with 0.125% bupivacaine and 0.2 microg kg(-1) fentanyl (basic infusion 1 mL h(-1), bolus 4 mL, lock-out time 15 min) or remifentanil PCA (0.2 microg kg(-1) bolus doses, without basic infusion, lock-out time 2 min). The intensity of pain was assessed using the VAS scale every 15 min in the PCEA group and every 10 min in the PCA group.
During the first two hours of labour, the VAS score was significantly lower in the PCEA group. Later there was no difference between the groups. The clinical status of the newborns was similar.
The results are difficult to interpret since there was no randomisation and parturients participated in decisions about allocation to one of the study groups. Analgesia provided by remifentanil was assessed as highly acceptable by the patients and the drug can be regarded as a safe alternative to epidural analgesia during labour.
尽管硬膜外麻醉已成为全球分娩镇痛的标准方法，但由于其副作用和禁忌证，远非理想选择。因此，人们提出了许多替代技术，包括持续输注瑞芬太尼。受正面报道的鼓舞，我们比较了患者自控瑞芬太尼输注（PCA）与患者自控连续硬膜外镇痛（PCEA）的效果。
52例ASA I级和II级产妇未随机分组，而是任意分为两组，分别接受含0.125%布比卡因和0.2μg·kg⁻¹芬太尼的PCEA（基础输注速率1 mL·h⁻¹，单次推注量4 mL，锁定时间15分钟）或瑞芬太尼PCA（单次推注剂量0.2μg·kg⁻¹，无基础输注，锁定时间2分钟）。PCEA组每15分钟、PCA组每10分钟使用视觉模拟评分法（VAS）评估疼痛强度。
在分娩的前两小时，PCEA组的VAS评分显著更低。之后两组之间无差异。新生儿的临床状况相似。
由于未进行随机分组且产妇参与了分组决策，结果难以解读。患者对瑞芬太尼提供的镇痛效果评价很高，该药物可被视为分娩期间硬膜外镇痛的安全替代方法。
