Anwari Jamil S, Khalil Laith, Terkawi Abdullah S
Department of Anesthesiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA ; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2015 Oct-Dec;9(4):370-5. doi: 10.4103/1658-354X.159457.
Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™) analgesia as bridging analgesia for epidural placement.
Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction) cycle, pain, Richmond Agitation Sedation Scale (RASS), nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded.
The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001), and continued to decrease significantly over the study period (P < 0.0001). The RASS scores continuously improved after each cycle (P < 0.0001). Only 1 parturient from the cohort became lightly sedated (RASS = -1). Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment.
Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.
在躁动的分娩妇女中建立硬膜外麻醉具有挑战性。在这种情况下，理想的疼痛控制技术应有效、起效快且作用时间短。我们评估了吸入用甲氧氟烷（Penthrox™）镇痛作为硬膜外穿刺置管的桥接镇痛的疗效。
64名要求硬膜外镇痛且疼痛评分≥7分的分娩妇女纳入一项观察性研究，其中56名完成了研究。产妇在子宫收缩疼痛发作前被指示使用该装置，并在子宫收缩高峰时停止，反复使用直至成功放置硬膜外导管。在每个（甲氧氟烷吸入 - 子宫收缩）周期后，评估疼痛、里士满躁动镇静量表（RASS）、恶心和呕吐情况。记录产妇和胎儿的血流动力学以及产妇满意度。
平均基线疼痛评分为8.2±1.5，首次吸入后降至6.2±2.0，平均差值为2.0±1.1（95%置信区间1.7 - 2.3，P < 0.0001），并且在研究期间持续显著下降（P < 0.0001）。每个周期后RASS评分持续改善（P < 0.0001）。队列中只有1名产妇出现轻度镇静（RASS = -1）。2名产妇呕吐，治疗期间未发现产妇血流动力学或胎儿心率有显著变化。67%的产妇对治疗表示非常满意或极其满意。
Penthrox™为分娩产妇硬膜外穿刺置管期间控制疼痛和躁动提供了快速、有效且令人满意的治疗方法。
