Farzi Farnoush, Mirmansouri Ali, Forghanparast Kambiz, Heydarzadeh Abtin, Abdollahzadeh Mehrsima, Jahanyar Moghadam Fatemeh
Deaprtment of Anesthesiology, Guilan University of Medical Sciences, Rasht, Iran.
Department of Microbiology, Guilan University of Medical Sciences, Rasht, Iran.
Anesth Pain Med. 2014 Feb 7;4(1):e14081. doi: 10.5812/aapm.14081. eCollection 2014 Feb.
A common and useful approach to pain management is administration of neuraxial opioids.
Whether addition of fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery has any effects on duration of postoperative pain.
This was a clinical trial, conducted on 195 pregnant women candidates for elective cesarean section. All patients were in ASA classes I, and II aged 17-45 years, and were randomly allocated to three groups named as meperidine (P), fentanyl (F), and placebo (S). In the three groups (P, F, and S), 25 mg meperidine, 25 µg fentanyl and 0.5 mL saline with lidocaine and epinephrine were injected into the subarachnoid space for spinal anesthesia, respectively. Perioperative complications and Apgar scores were recorded. Duration of analgesia was measured from the end of operation for 24 hours by using VAS. The first VAS≥4 was recorded as the end of the painless period. Characteristics of sensory and motor block were assessed. Statistical analysis was performed with SPSS software.
The mean duration of analgesia with meperidine, fentanyl or placebo were 9.46 ± 0.6, 6.27 ± 0.45, 2.06 ± 0.13 hours, respectively (P < 0.0001). There was significant difference between the group P and the other groups. Patients on meperidine had faster, longer and higher sensory block (P < 0.0001) and faster and longer motor block (P < 0.0001). Frequency of sedation in the group F was more than the others (P < 0.026). There was no difference in Apgar scores between the three groups (P < 0.45).
Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia in cesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.
神经轴索类阿片药物给药是一种常用的疼痛管理方法。
在择期剖宫产脊髓麻醉中，向利多卡因和肾上腺素中添加芬太尼或哌替啶是否会对术后疼痛持续时间产生影响。
这是一项针对195名择期剖宫产孕妇的临床试验。所有患者均为ASA I级和II级，年龄在17至45岁之间，随机分为三组，分别为哌替啶组（P）、芬太尼组（F）和安慰剂组（S）。在三组（P、F和S）中，分别将25毫克哌替啶、25微克芬太尼和0.5毫升含利多卡因和肾上腺素的生理盐水注入蛛网膜下腔进行脊髓麻醉。记录围手术期并发症和阿氏评分。使用视觉模拟评分法（VAS）从手术结束起测量24小时的镇痛持续时间。首次VAS≥4被记录为无痛期结束。评估感觉和运动阻滞的特征。使用SPSS软件进行统计分析。
哌替啶、芬太尼或安慰剂的平均镇痛持续时间分别为9.46±0.6、6.27±0.45、2.06±0.13小时（P<0.0001）。P组与其他组之间存在显著差异。使用哌替啶的患者感觉阻滞更快、持续时间更长且程度更高（P<0.0001），运动阻滞更快且持续时间更长（P<0.0001）。F组的镇静频率高于其他组（P<0.026）。三组之间的阿氏评分无差异（P<0.45）。
在利多卡因和肾上腺素溶液中添加哌替啶或芬太尼可延长剖宫产术后镇痛的持续时间。根据更长的镇痛持续时间和更低的并发症，哌替啶是推荐的辅助药物。
