Obstetric Anesthesia Research Unit, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Can J Anaesth. 2010 May;57(5):468-78. doi: 10.1007/s12630-010-9289-1. Epub 2010 Mar 13.
Modern neuraxial labour analgesia reflects a shift in obstetrical anesthesia thinking - away from a simple focus on pain relief towards a focus on the overall quality of analgesia. However, advances in the methods used to measure outcomes have not kept pace with clinical progress, and these approaches must evolve to facilitate meaningful assessment of the advances provided towards the quality of analgesia. Developing a tool to measure the quality of neuraxial labour analgesia that research has achieved is best guided by women's perspectives. As the initial step in developing an instrument to quantitatively measure quality neuraxial labour analgesia, this qualitative descriptive study explored childbearing women's experiences and perspectives regarding this subject.
Twenty-eight postpartum women, all delivering with neuraxial labour analgesia, were recruited from three hospitals in the greater Toronto area. Twenty-five women described a priori plans to use neuraxial labour analgesia, or they described themselves as having been open to the idea. Women's experiences and perspectives of neuraxial labour analgesia were explored in focus groups and in-depth interviews < or =72 hr following childbirth.
Four major themes emerged: 1)The Enormity of Labour Pain; 2) Fear and Anxiety Related to Epidural Pain Relief; 3) What Women Value about Epidural Pain Relief; and 4) The Relative Value of Achieving Epidural Pain Relief vs Avoidance of Epidural Drug Side Effects. Participants broadly described quality neuraxial labour analgesia as pain relief without side effects. Responses affirmed the importance of traditionally measured outcomes as attributes of quality neuraxial labour analgesia, e.g., pain relief and side effects, as well as the overall importance of pain control during labour and delivery. For research to capture the experience of quality neuraxial labour analgesia, findings suggest that this outcome involves physical, cognitive, and emotional dimensions that must be measured. The findings further suggest an important relationship between each of these dimensions and perceptions of control.
Women's perspectives must be incorporated into the assessment of quality neuraxial labour analgesia in order for research to measure this outcome in a meaningful manner. Study findings have important implications for scale development, interpretation of existing research, and antenatal education.
现代的椎管内分娩镇痛反映了产科麻醉思维的转变——从单纯关注疼痛缓解转向关注整体镇痛质量。然而，用于衡量结果的方法的进步并没有跟上临床的进步，这些方法必须发展，以促进对镇痛质量的进步进行有意义的评估。开发一种衡量椎管内分娩镇痛质量的工具，最好以女性的观点为指导。作为开发一种定量测量质量的椎管内分娩镇痛仪器的第一步，这项定性描述性研究探讨了产妇对这一主题的经验和观点。
从大多伦多地区的三家医院招募了 28 名接受椎管内分娩镇痛的产后妇女。25 名妇女描述了她们事先计划使用椎管内分娩镇痛的情况，或者她们说自己对这个想法持开放态度。在分娩后 72 小时内，通过焦点小组和深入访谈探讨了妇女对椎管内分娩镇痛的经验和观点。
出现了四个主要主题：1. 分娩疼痛的巨大性；2. 与硬膜外疼痛缓解相关的恐惧和焦虑；3. 女性对硬膜外疼痛缓解的重视；4. 实现硬膜外疼痛缓解与避免硬膜外药物副作用的相对价值。参与者广泛地将质量好的椎管内分娩镇痛描述为没有副作用的疼痛缓解。她们的回答肯定了传统上衡量的结果作为质量好的椎管内分娩镇痛的属性的重要性，例如疼痛缓解和副作用，以及分娩和分娩期间疼痛控制的整体重要性。为了使研究能够以有意义的方式捕捉到质量好的椎管内分娩镇痛的体验，研究结果表明，这种结果涉及到必须衡量的身体、认知和情感方面。研究结果进一步表明，这些维度中的每一个维度与控制感之间存在重要关系。
为了使研究能够以有意义的方式衡量这一结果，必须将女性的观点纳入椎管内分娩镇痛质量的评估中。研究结果对量表的发展、对现有研究的解释以及产前教育具有重要意义。
