Srivastava Uma, Gupta Amrita, Saxena Surekha, Kumar Aditya, Singh Saroj, Saraswat Namita, Mishra Abhijeet R, Kannaujia Ashish, Mishra Sukhdev
Professor, Research scholar Agra University.
Indian J Anaesth. 2009 Dec;53(6):649-53.
Patient controlled epidural analgesia (PCEA) is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 microg.ml(-1) of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8) required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable & prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine, it did not affect maternal or neonatal safety.
患者自控硬膜外镇痛（PCEA）是一种成熟的分娩镇痛技术。但在PCEA中加入持续背景输注存在争议。本研究的目的是评估与单纯PCEA相比，PCEA联合持续输注在镇痛质量、产妇满意度和新生儿结局方面对分娩妇女是否有益。55名产妇接受了10ml含0.125%布比卡因+2μg/ml芬太尼溶液的硬膜外推注。为维持镇痛，PCEA组患者按需自行推注上述溶液8ml，锁定时间为20分钟，无基础输注。而PCEA + CI组患者在自行推注3ml、锁定时间为10分钟的类似硬膜外溶液的同时，以10ml/小时的速率接受持续硬膜外输注。两组患者在疼痛难忍时均由麻醉师给予补救推注。记录视觉模拟疼痛评分、疼痛难忍的发生率、补充/补救推注的需求、布比卡因的消耗量、产妇满意度和新生儿阿普加评分。分娩期间的平均VAS疼痛评分、产妇满意度、分娩方式或新生儿阿普加评分之间未观察到显著差异。但PCEA组有更多患者（n = 8）因疼痛难忍需要补救推注。PCEA + CI组布比卡因和阿片类药物的总消耗量略多。在两种技术中，最高感觉平面、运动阻滞程度相当，且未观察到产程延长。结论是两种技术在分娩镇痛、产妇满意度和新生儿阿普加评分方面相当。PCEA联合10ml/小时的持续输注导致疼痛难忍的发生率和补救镇痛的需求较低。虽然该组布比卡因剂量较高，但不影响产妇或新生儿安全。
