Murphy J D, Henderson K, Bowden M I, Lewis M, Cooper G M
Department of Anaesthetics, Birmingham Maternity Hospital, Queen Elizabeth Medical Centre.
BMJ. 1991 Mar 9;302(6776):564-7. doi: 10.1136/bmj.302.6776.564.
To compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labour and to evaluate factors in addition to analgesia that may influence maternal satisfaction.
A prospective randomised pilot study.
Birmingham Maternity Hospital.
85 primiparous women who requested epidural analgesia in labour and their babies.
Group 1 mothers were treated with bupivacaine conventionally, group 2 mothers with bupivacaine and fentanyl in a more complex way designed to provide satisfactory analgesia but with less troublesome side effects.
Overall maternal satisfaction, maternal perception of epidural analgesia and its side effects, and aspects of mothers' psychological states during labour, quantified using 100 mm visual linear analogue scales; the frequency of normal and operative deliveries; and measurements of neonatal wellbeing.
Satisfaction was higher in group 2 mothers (median group difference +3 mm, 95% confidence interval +1 to +5, p = 0.012): this was associated with more normal deliveries (difference between proportions 0.23, 95% confidence interval +0.03 to +0.42); greater self control (median group difference -7 mm, -17 to -2, p = 0.003); and reduced unpleasantness of motor blockade (-10 mm, -19 to -5, p less than 0.001), sensory blockade (-5 mm, -11 to -2, p = 0.002) and shivering (-5 mm, -18 to 0, p = 0.046) at the expense of mild itching (0 mm, 0 to 0, p less than 0.001). Group 1 mothers found restricted movements more unpleasant (-1 mm, -11 to 0, p = 0.006) and were more sleepy (-4 mm, -20 to 0, p = 0.032). The addition of fentanyl to bupivacaine reduced the requirement for local anaesthetic (-33 mg, -55 to -15, p less than 0.001) without compromising analgesia. No adverse effects in neonates were attributed to the use of fentanyl.
The already high maternal satisfaction from conventional epidural analgesia can be improved; epidural fentanyl may be combined with bupivacaine to reduce operative deliveries and confer other advantages that may increase maternal satisfaction. Further investigations should be performed to determine the exact mechanisms of these findings and, in particular, to develop a safe method of delivering such analgesia to women.
比较硬膜外给予芬太尼和布比卡因的联合用药与单纯使用布比卡因用于分娩镇痛的效果，并评估除镇痛外可能影响产妇满意度的因素。
前瞻性随机试验研究。
伯明翰妇产医院。
85名要求分娩时进行硬膜外镇痛的初产妇及其婴儿。
第1组母亲按常规使用布比卡因治疗，第2组母亲以更复杂的方式使用布比卡因和芬太尼，旨在提供满意的镇痛效果，同时减少不良副作用。
总体产妇满意度、产妇对硬膜外镇痛及其副作用的认知，以及分娩期间母亲心理状态的各个方面，使用100毫米视觉线性模拟量表进行量化；正常分娩和手术分娩的频率；以及新生儿健康状况的测量。
第2组母亲的满意度更高（组间中位数差异+3毫米，95%置信区间+1至+5，p = 0.012）：这与更多的正常分娩相关（比例差异0.23，95%置信区间+0.03至+0.42）；更强的自我控制感（组间中位数差异-7毫米，-17至-2，p = 0.003）；以及运动阻滞（-10毫米，-19至-5，p<0.001）、感觉阻滞（-5毫米，-11至-2，p = 0.002）和寒战（-5毫米，-18至0，p = 0.046）的不适感减轻，但代价是有轻度瘙痒（0毫米，0至0，p<0.001）。第1组母亲发现活动受限更令人不适（-1毫米，-11至0，p = 0.006），且更易困倦（-4毫米，-20至0，p = 0.032）。布比卡因中添加芬太尼可减少局部麻醉药的用量（-33毫克，-55至-15，p<0.001），且不影响镇痛效果。未发现芬太尼的使用对新生儿有不良影响。
传统硬膜外镇痛本已较高的产妇满意度可进一步提高；硬膜外给予芬太尼可与布比卡因联合使用，以减少手术分娩，并带来其他可能提高产妇满意度的优势。应进行进一步研究以确定这些发现的确切机制，特别是要开发一种向女性提供此类镇痛的安全方法。
