Costa-Martins José Manuel, Pereira Marco, Martins Henriqueta, Moura-Ramos Mariana, Coelho Rui, Tavares Jorge
Department of Anaesthesiology, Maternity Alfredo da Costa , Lisbon , Portugal .
Chronobiol Int. 2014 Jul;31(6):787-96. doi: 10.3109/07420528.2014.901973. Epub 2014 Mar 27.
Circadian variation in biological rhythms has been identified as affecting both labour pain and the pharmacological properties of analgesics. In the context of pain, there is also a growing body of evidence suggesting the importance of adult attachment. The purpose of this study was to examine whether labour pain, analgesic consumption and pharmacological effect are significantly affected by the time of day and to analyse whether this circadian variation is influenced by women's attachment style. This prospective observational study included a sample of 81 pregnant women receiving patient-controlled epidural analgesia (PCEA). Attachment was assessed with the Adult Attachment Scale - Revised. The perceived intensity of labour pain in the early stage of labour (3 cm of cervical dilatation and before the administration of PCEA) was measured using a visual analogue scale (VAS). Pain was also indirectly assessed by measuring the consumption of anaesthetics. The latency period and the duration of effect were recorded for a chronopharmacology characterisation. Pain, as assessed with the VAS, was significantly higher in the night-time group than in the daytime group. An insecure attachment style was significantly associated with greater labour pain at 3 cm of cervical dilatation (p < 0.001) and before the beginning of analgesia (p < 0.001) as well as with higher analgesic consumption and lower pharmacological efficacy (p < 0.05). The time of day was significantly associated with the pharmacological effect: the latency period was longer at night, and the duration of the pharmacological effect was longer during the daytime. The interaction between time of day and attachment style was not significant for any of the study variables. Our results provide evidence of the importance of circadian variation in studying labour pain and the pharmacological effect of labour analgesia involving epidural blockage with a PCEA regimen. Moreover, although there was no evidence that attachment style influenced the circadian variation, these data emphasise that insecure attachment patterns are a risk factor for greater labour pain and analgesic consumption, which should be considered in pain management approaches.
生物节律的昼夜变化已被确定为会影响分娩疼痛和镇痛药的药理特性。在疼痛方面，也有越来越多的证据表明成人依恋的重要性。本研究的目的是检查分娩疼痛、镇痛药消耗量和药理作用是否受一天中的时间显著影响，并分析这种昼夜变化是否受女性依恋风格的影响。这项前瞻性观察研究纳入了81名接受患者自控硬膜外镇痛（PCEA）的孕妇样本。使用修订后的成人依恋量表评估依恋情况。使用视觉模拟量表（VAS）测量分娩早期（宫颈扩张3厘米且在给予PCEA之前）分娩疼痛的感知强度。还通过测量麻醉剂消耗量间接评估疼痛。记录潜伏期和作用持续时间以进行时辰药理学特征分析。用VAS评估的疼痛在夜间组显著高于白天组。不安全依恋风格与宫颈扩张3厘米时（p＜0.001）和镇痛开始前（p＜0.001）更大的分娩疼痛以及更高的镇痛药消耗量和更低的药理疗效显著相关（p＜0.05）。一天中的时间与药理作用显著相关：夜间潜伏期更长，白天药理作用持续时间更长。一天中的时间和依恋风格之间的相互作用对任何研究变量均无显著意义。我们的结果提供了证据，证明昼夜变化在研究分娩疼痛和采用PCEA方案进行硬膜外阻滞的分娩镇痛药理作用方面的重要性。此外，尽管没有证据表明依恋风格会影响昼夜变化，但这些数据强调不安全依恋模式是更大分娩疼痛和镇痛药消耗量的危险因素，在疼痛管理方法中应予以考虑。
