在私人执业环境中硬膜外镇痛与腰硬联合麻醉的随机对照比较：第一产程和第二产程及分娩时的疼痛评分。

A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery.

机构信息

Department of Anesthesiology, Sharp Mary Birch Hospital for Women and Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.

出版信息

Anesth Analg. 2013 Mar;116(3):636-43. doi: 10.1213/ANE.0b013e31827e4e29. Epub 2013 Feb 11.

DOI:10.1213/ANE.0b013e31827e4e29

PMID:23400985

Abstract

BACKGROUND

There has been no prospective evaluation of combined spinal-epidural (CSE) analgesia in a private practice setting and few studies have focused on pain relief during the second stage of labor and at delivery. In this randomized controlled trial, we compared verbal pain scores during the first and second stages of labor and at delivery in women receiving CSE or traditional epidural analgesia at a busy private maternity hospital.

METHODS

Healthy, term parturients received epidural or CSE analgesia for labor pain upon request. Epidural analgesia was initiated with 0.125% bupivacaine plus 2 μg/mL fentanyl, 15 mL; CSE analgesia was initiated with intrathecal plain bupivacaine 3.125 mg plus 5 μg fentanyl. Thereafter, patient-controlled epidural analgesia with 0.125% bupivacaine plus 2 μg/mL fentanyl was used for maintenance analgesia in both groups. The primary outcome was an assessment of "typical" pain, using a verbal rating pain score from 0 to 10, made at the end of the first stage of labor and shortly after delivery.

RESULTS

Data from 398 epidural and 402 CSE subjects were analyzed. The typical verbal rating pain score during the first stage was lower in the CSE group (mean: 1.4 vs 1.9; P < 0.001; 99.5% confidence interval [CI] for difference: -0.92, -0.14). Pain scores during the second stage of labor (1.7 vs 1.9; P = 0.17; 99.5% CI for difference: -0.82, 0.28) and at delivery (2.0 vs 2.0; P = 0.77; 99.5% CI for difference: -0.73, 0.59) were the same between groups. Fewer patients received an epidural top-up dose in the CSE group (16.4% vs 25.6%; P = 0.002; 99.5% CI for difference: -17.0%, -1.0%). Epidural catheters were replaced in 1.2% CSE vs 2% in the epidural group (P = 0.39; 99.5% CI for difference: -3.3%, 1.8%).

CONCLUSIONS

Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist.

摘要

背景

目前尚无关于私人执业环境中联合脊麻-硬膜外（CSE）镇痛的前瞻性评估，并且很少有研究关注第二产程和分娩时的镇痛效果。在这项随机对照试验中，我们比较了在一家繁忙的私立妇产医院中，接受 CSE 或传统硬膜外镇痛的产妇在第一产程、第二产程和分娩时的口述疼痛评分。

方法

健康足月产妇在分娩时按需接受硬膜外或 CSE 镇痛。硬膜外镇痛起始剂量为 0.125%布比卡因加 2μg/mL 芬太尼，15mL；CSE 镇痛起始剂量为 3.125mg 布比卡因加 5μg 芬太尼。此后，两组均采用患者自控硬膜外镇痛，用 0.125%布比卡因加 2μg/mL 芬太尼维持镇痛。主要结局是评估第一产程结束时和分娩后不久的“典型”疼痛，使用 0 到 10 的口述疼痛评分。

结果

对 398 例硬膜外镇痛和 402 例 CSE 受试者的数据进行了分析。CSE 组的典型口述疼痛评分在第一产程时较低（均值：1.4 比 1.9；P<0.001；差值的 99.5%置信区间[CI]：-0.92，-0.14）。第二产程（1.7 比 1.9；P=0.17；差值的 99.5%CI：-0.82，0.28）和分娩时（2.0 比 2.0；P=0.77；差值的 99.5%CI：-0.73，0.59）的疼痛评分在两组之间相同。CSE 组接受硬膜外追加剂量的患者较少（16.4%比 25.6%；P=0.002；差值的 99.5%CI：-17.0%，-1.0%）。CSE 组中有 1.2%的患者需要更换硬膜外导管，而硬膜外组有 2%（P=0.39；差值的 99.5%CI：-3.3%，1.8%）。