Imani Farnad, Entezary Saeid Reza, Alebouyeh Mahmoud Reza, Parhizgar Suzan
Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.
Department of Anesthesiology, Texas Tech University, Health Science Center, Lubbock, Texas, USA.
Anesth Pain Med. 2011 Jul;1(1):25-9. doi: 10.5812/kowsar.22287523.1271. Epub 2011 Jul 1.
Opioid analgesics are commonly added to epidural local anesthetics to improve analgesia during surgery.
The goal of this study was to evaluate the maternal and neonatal effects of adding different doses of tramadol to 2% lidocaine in the epidural anesthesia for cesarean section.
Ninety pregnant patients who were candidates for cesarean section under epidural anesthesia were randomly categorized into three groups. Group L received 2% lidocaine. In the LT50 and LT100 groups, 50 and 100 mg of tramadol were added to epidural 2% lidocaine. For additional analgesia during surgery, 2% lidocaine through epidural catheter or IV sufentanil were administered. Analgesia after surgery was provided by IV injection of meperidine. Onset and duration of sensory and motor blockades, total drug consumption, neonatal Apgar score, and complications were recorded.
In the LT100 group, onset of complete sensory and motor blockade at T6 was less than in the two other groups, but the highest level of sensory blockade and two segment regression and duration of motor blockades between the LT50 and LT100 groups were not significantly different, although they were higher and more prolonged than in the L group. Average lidocaine and sufentanil consumption during surgery between the LT50 and LT100 groups were not significantly different but were lower than in the L group. The incidence of maternal complications and neonatal Apgar scores were not significantly different between the three groups. In the LT50 and LT100 groups, the time until the first request for analgesics after surgery was prolonged, and average meperidine consumption was less than in the L group.
The addition of tramadol to epidural 2% lidocaine offers advantages in cesarean section.
阿片类镇痛药通常添加到硬膜外局部麻醉药中，以改善手术期间的镇痛效果。
本研究的目的是评估在剖宫产硬膜外麻醉中，向2%利多卡因中添加不同剂量曲马多对母婴的影响。
90例拟行硬膜外麻醉下剖宫产的孕妇被随机分为三组。L组接受2%利多卡因。在LT50组和LT100组中，分别向硬膜外2%利多卡因中添加50 mg和100 mg曲马多。术中如需额外镇痛，可通过硬膜外导管给予2%利多卡因或静脉注射舒芬太尼。术后通过静脉注射哌替啶提供镇痛。记录感觉和运动阻滞的起效时间和持续时间、总药物消耗量、新生儿阿氏评分及并发症。
LT100组T6节段完全感觉和运动阻滞的起效时间短于其他两组，但LT50组和LT100组之间的最高感觉阻滞平面、两个节段的消退情况及运动阻滞持续时间虽高于L组且持续时间更长，但差异无统计学意义。LT50组和LT100组术中利多卡因和舒芬太尼的平均消耗量差异无统计学意义，但低于L组。三组间产妇并发症发生率和新生儿阿氏评分差异无统计学意义。在LT50组和LT100组中，术后至首次要求镇痛的时间延长，哌替啶平均消耗量低于L组。 结论：在剖宫产中，向硬膜外2%利多卡因中添加曲马多具有优势。
