Mousa Wesam F, Al-Metwalli R R, Mostafa Manal
Tanta University, Egypt.
Middle East J Anaesthesiol. 2010 Feb;20(4):521-7.
Although lidocaine is a cheap and globally available local anesthetic, yet it is not a popular drug for labor analgesia. This is claimed to its higher intensity of motor block, possibility of transient neurological symptoms (TNS) and its placental transfer with probable drawbacks on fetal well-being. However, these effects could be concentration dependent and, the evidence linking them to lidocaine is still lacking. This study was designed to evaluate the efficacy and safety of 0.5% epidural lidocaine plus fentanyl during labor.
One hundred and twenty healthy full term nulliparous women in early labor with a single fetus presented by the vertex were enrolled in this randomized, double-blind clinical trial. Parturient were assigned to receive epidural analgesia either with lidocaine 0.5% plus fentanyl 2 microg(-1 mL) (LF), or ropivacaine 0.08% plus fentanyl 2 microg(-1 ml) (RF) when their cervix was dilated to 4 centimeters. Analgesia was provided with 20 ml bolus of the study solution and maintained at 10 ml(-1) h. Upper level of sensory loss to cold, Visual Analogue Pain Score (VAPS), motor block (modified Bromage score), the duration of the first and second stages of labor, numbers of instrumental vaginal and cesarean deliveries, the neonatal apgar score, patient satisfaction and side effects, were recorded.
There were no significant differences in sensory level, pain scores, duration of the first and second stages of labor, numbers of instrumental and cesarean deliveries, the neonatal apgar scores, patient satisfaction or side effect between groups. Although motor block was significantly high in lidocaine group compared to ropivacaine group (p < 0.05), all parturient were moving satisfactorily in bed.
Dilute epidural lidocaine (0.5%) with fentanyl effectively and safely initiates epidural analgesia clinically indistinguishable from 0.08% epidural ropivacaine with fentanyl. Although it induces significant motor block compared to ropivacaine, it still preserves maternal ability to move satisfactorily in bed. Whether further reduction in lidocaine concentration could trim down the motor block, remains to be investigated.
尽管利多卡因是一种价格低廉且全球通用的局部麻醉剂，但它并非分娩镇痛的常用药物。这据称是由于其运动阻滞强度较高、存在短暂性神经症状（TNS）的可能性以及其胎盘转运可能对胎儿健康产生不利影响。然而，这些影响可能与浓度有关，且将它们与利多卡因联系起来的证据仍然不足。本研究旨在评估分娩期间0.5%硬膜外利多卡因加芬太尼的疗效和安全性。
120名单胎头先露的健康足月初产妇在产程早期被纳入这项随机、双盲临床试验。当产妇宫颈扩张至4厘米时，将其分为两组，分别接受0.5%利多卡因加2微克（-1毫升）芬太尼（LF）或0.08%罗哌卡因加2微克（-1毫升）芬太尼（RF）的硬膜外镇痛。给予20毫升研究溶液推注进行镇痛，并以每小时10毫升的速度维持。记录冷觉感觉丧失的上界、视觉模拟疼痛评分（VAPS）、运动阻滞（改良Bromage评分）、第一和第二产程的持续时间、器械助产和剖宫产的次数、新生儿阿氏评分、患者满意度及副作用。
两组在感觉平面、疼痛评分、第一和第二产程的持续时间、器械助产和剖宫产的次数、新生儿阿氏评分、患者满意度或副作用方面均无显著差异。尽管利多卡因组的运动阻滞明显高于罗哌卡因组（p < 0.05），但所有产妇在床上的活动情况均令人满意。
稀释的硬膜外0.5%利多卡因加芬太尼在临床上能有效、安全地启动硬膜外镇痛，与0.08%硬膜外罗哌卡因加芬太尼无异。尽管与罗哌卡因相比，它会引起明显的运动阻滞，但仍能保持产妇在床上满意活动的能力。利多卡因浓度进一步降低是否能减少运动阻滞，仍有待研究。
