Gambling D R, McMorland G H, Yu P, Laszlo C
Department of Anaesthesia, University of British Columbia, Vancouver, Canada.
Anesth Analg. 1990 Mar;70(3):256-61. doi: 10.1213/00000539-199003000-00005.
In a prospective, randomized manner, bolus injection patient-controlled epidural analgesia (PCEA; n = 30) and conventional intermittent "top-up" injections (CIT; n = 28) of bupivacaine in nulliparous parturients during first stage of labor were compared. Group A (PCEA) patients self-administered, using a patient-controlled analgesia device, 4-mL increments of 0.125% bupivacaine with 1: 400,000 epinephrine, to a maximum 12 mL/h as required. Group B (CIT) patients received 12 mL of the same solution, on request, from the anesthesiologist. Hourly assessments of pain relief (visual analogue scale), satisfaction, sensory and motor block, blood pressure, and cervical dilatation were made. In addition, retrospective pain assessments were made in patients requesting analgesia in the preceding hour, indicating their maximum pain during that time. The groups were demographically comparable and equally low hourly bupivacaine requirements were seen (group A, 6.36 +/- 0.43 mg; group B, 6.23 +/- 0.39 mg) producing similar mean sensory levels. Pain relief obtained in both groups was similar but was associated with greater satisfaction in patients using PCEA (P less than 0.05). This study shows that PCEA is a viable alternative for providing pain relief in the first stage of labor.
采用前瞻性随机方法，比较了初产妇在第一产程中使用布比卡因进行单次注射患者自控硬膜外镇痛（PCEA；n = 30）和传统间歇性“追加”注射（CIT；n = 28）的效果。A组（PCEA）患者使用患者自控镇痛装置自行给药，每次追加4 mL含1:400,000肾上腺素的0.125%布比卡因，根据需要最大剂量为12 mL/h。B组（CIT）患者根据需要从麻醉医生处接受12 mL相同溶液。每小时评估疼痛缓解情况（视觉模拟评分）、满意度、感觉和运动阻滞、血压及宫颈扩张情况。此外，对前一小时要求镇痛的患者进行回顾性疼痛评估，记录其当时的最大疼痛程度。两组在人口统计学上具有可比性，每小时布比卡因需求量同样较低（A组，6.36±0.43 mg；B组，6.23±0.39 mg），产生的平均感觉平面相似。两组获得的疼痛缓解效果相似，但PCEA组患者的满意度更高（P<0.05）。本研究表明，PCEA是第一产程中提供疼痛缓解的一种可行替代方法。
