Lier Marit C, Douwenga Wieteke M, Yilmaz Fatos, Schats Roel, Hompes Peter G, Boer Christa, Mijatovic Velja
Department of Reproductive Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, the Netherlands.
Pain Pract. 2015 Jun;15(5):487-95. doi: 10.1111/papr.12189. Epub 2014 Apr 12.
Pethidine with midazolam-induced conscious sedation for pain relief during transvaginal oocyte retrieval for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedures is associated with residual pain and oversedation. Patient-controlled analgesia (PCA) with remifentanil may serve as an alternative for pethidine. We investigated whether PCA remifentanil with diclofenac was associated with improved periprocedural pain relief than pethidine analgesia during IVF/ICSI procedures, with sedation scores, safety profiles, and patient satisfaction as secondary endpoints.
Seventy-six women were randomized to receive pethidine (2 mg/kg i.m.) and midazolam (7.5 mg)-induced conscious sedation (n = 40) or PCA with remifentanil and diclofenac (50 mg; n = 36). The Numeric Rating Scale, McGill Pain Questionnaire (MPQ), Ramsey Sedation Scale, and a 5-day pain-and-discomfort diary were used to evaluate pain and sedation levels.
There were no differences in baseline characteristics and reproductive outcomes between both groups. Periprocedural pain scores were comparable for remifentanil and pethidine groups (4 [3 to 7] vs. 6 [4 to 8]; P = 0.13). Pain scores in the pethidine group were significantly lower at 30 minutes after the procedure (1 [0 to 3] vs. 2 [1 to 5]; P = 0.016), but at cost of higher sedation levels when compared to remifentanil (4 [2 to 4] vs. 2 [2 to 2]; P < 0.001). Patient satisfaction was higher, and MPQ scores were lower in the remifentanil group. There were no differences in safety profiles between both analgesics.
Patient-controlled analgesia with remifentanil showed a similar reduction in pain scores than pethidine with midazolam during oocyte retrieval, while pethidine induced the highest pain relief after the procedure. However, PCA remifentanil was associated with less sedation and a better patient satisfaction profile than pethidine.
在体外受精（IVF）或卵胞浆内单精子注射（ICSI）的经阴道取卵过程中，哌替啶联合咪达唑仑诱导的清醒镇静用于缓解疼痛，与残留疼痛和过度镇静相关。瑞芬太尼患者自控镇痛（PCA）可作为哌替啶的替代方法。我们研究了在IVF/ICSI过程中，与哌替啶镇痛相比，瑞芬太尼联合双氯芬酸的PCA是否能改善围手术期疼痛缓解情况，并将镇静评分、安全性和患者满意度作为次要终点。
76名女性被随机分为两组，一组接受哌替啶（2mg/kg肌肉注射）联合咪达唑仑（7.5mg）诱导的清醒镇静（n = 40），另一组接受瑞芬太尼联合双氯芬酸（50mg）的PCA（n = 36）。使用数字评分量表、麦吉尔疼痛问卷（MPQ）、拉姆齐镇静量表和一份为期5天的疼痛与不适日记来评估疼痛和镇静水平。
两组的基线特征和生殖结局无差异。瑞芬太尼组和哌替啶组的围手术期疼痛评分相当（4[3至7]对6[4至8]；P = 0.13）。哌替啶组术后30分钟的疼痛评分显著更低（1[0至3]对2[1至5]；P = 0.016），但与瑞芬太尼相比，镇静水平更高（4[2至4]对2[2至2]；P < 0.001）。瑞芬太尼组的患者满意度更高，MPQ评分更低。两种镇痛药的安全性无差异。
在取卵过程中，瑞芬太尼患者自控镇痛与哌替啶联合咪达唑仑相比，疼痛评分降低程度相似，而哌替啶在术后疼痛缓解效果最佳。然而，与哌替啶相比，瑞芬太尼PCA导致的镇静作用更小，患者满意度更高。
