Kumar T Senthil, Rani P, Hemanth Kumar V R, Samal Sunita, Parthasarathy S, Ravishankar M
Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India.
Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India.
Anesth Essays Res. 2017 Jan-Mar;11(1):28-33. doi: 10.4103/0259-1162.194573.
Quality of labor analgesia plays a vital role in the maternal outcome. Very few literature are available analyzing the quality of epidural labor analgesia.
The aim of this study was to compare the effectiveness of 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl as an adjuvant for epidural labor analgesia in terms of onset, duration, quality of analgesia, and degree of motor blockade.
Sixty nulliparous parturients, with singleton uncomplicated pregnancy, were recruited by continuous sampling. Parturients were randomized to receive either levobupivacaine 0.1% or ropivacaine 0.1% with 2 μg/ml fentanyl as an intermittent epidural bolus. The epidural analgesia was initiated with 12 ml of study drug solution in the active stage of labor (cervix 3 cm dilated). Demand bolus was given whenever the visual analog scale (VAS) score >3. Onset, duration, and quality of analgesia and degree of motor blockade were analyzed. Maternal outcome was evaluated in terms of mode of delivery, duration of labor, and assisted vaginal delivery.
All the data were recorded in Microsoft Office Excel. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, USA) software with Regression Modules installed. Descriptive analyses were reported as mean and standard deviation of continuous variables.
The mean onset of analgesia was shorter in ropivacaine (21.43 ± 2 min) than in levobupivacaine group (23.57 ± 1.71 min) ( = 0.000). Duration of analgesia was shorter in ropivacaine (60 ± 14 min) than levobupivacaine (68 ± 11 min) ( = 0.027). Levobupivacaine produced a better quality of analgesia in terms of not perceiving pain and uterine contraction during labor analgesia but was associated with 37% incidence of instrumental delivery. Duration of labor and rate of cesarean section were comparable between the groups.
Quality of analgesia in labor epidural was superior to levobupivacaine but was associated with higher incidence of instrumental vaginal delivery.
分娩镇痛质量对产妇结局起着至关重要的作用。目前分析硬膜外分娩镇痛质量的文献很少。
本研究旨在比较0.1%左旋布比卡因和0.1%罗哌卡因联合芬太尼作为硬膜外分娩镇痛辅助药物在起效时间、持续时间、镇痛质量和运动阻滞程度方面的有效性。
通过连续抽样招募60例单胎妊娠、无并发症的初产妇。将产妇随机分为两组，分别接受0.1%左旋布比卡因或0.1%罗哌卡因加2μg/ml芬太尼作为间歇性硬膜外推注。在产程活跃期（宫颈扩张3cm）开始时用12ml研究药物溶液进行硬膜外镇痛。每当视觉模拟评分（VAS）>3分时给予按需推注。分析镇痛的起效时间、持续时间、质量和运动阻滞程度。从分娩方式、产程持续时间和阴道助产方面评估产妇结局。
所有数据记录在Microsoft Office Excel中。使用安装了回归模块的SPSS 19.0版（美国IBM SPSS）软件进行统计分析。连续变量的描述性分析以均值和标准差表示。
罗哌卡因组镇痛的平均起效时间（21.43±2分钟）比左旋布比卡因组（23.57±1.71分钟）短（P=0.000）。罗哌卡因组的镇痛持续时间（60±14分钟）比左旋布比卡因组（68±11分钟）短（P=0.027）。在分娩镇痛期间不感知疼痛和子宫收缩方面，左旋布比卡因产生了更好的镇痛质量，但与37%的器械助产发生率相关。两组间产程持续时间和剖宫产率相当。
硬膜外分娩镇痛中罗哌卡因的镇痛质量优于左旋布比卡因，但与器械助产的较高发生率相关。
