Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong SAR.
Anaesthesia. 2011 Sep;66(9):796-801. doi: 10.1111/j.1365-2044.2011.06790.x. Epub 2011 Jun 24.
In a prospective, double-blind, randomised controlled trial, we compared the efficacy of patient-controlled analgesia using remifentanil (25-30 μg per bolus) with intramuscular pethidine (50-75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8-9.2) h) compared with intramuscular pethidine (4.9 (3.8-5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular pethidine (p= 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular pethidine. At this dose, maternal and fetal side effects were uncommon.
在一项前瞻性、双盲、随机对照试验中，我们比较了瑞芬太尼（25-30μg/ 次）患者自控镇痛与肌肉注射哌替啶（50-75mg）用于分娩镇痛的效果，共纳入 69 名产妇。接受患者自控镇痛的产妇在整个研究期间报告的疼痛程度低于接受肌肉注射哌替啶的产妇（p<0.001），在开始镇痛后 2 小时疼痛视觉模拟评分的最大降低（患者自控镇痛组为 20（17），肌肉注射哌替啶组为 36（22））。与肌肉注射哌替啶相比，患者自控镇痛组首次要求解救镇痛的中位（95%CI）时间明显更长（8.0（6.8-9.2）h），差异有统计学意义（p<0.001）。与肌肉注射哌替啶相比，瑞芬太尼的产妇满意度评分也更高（p=0.001）。两组均未报告镇静、呼吸暂停或氧饱和度下降，且两组的 Apgar 评分相似。我们的结论是，与肌肉注射哌替啶相比，瑞芬太尼患者自控镇痛能提供更好的分娩镇痛和产妇满意度。在这个剂量下，产妇和胎儿的副作用并不常见。
