Staikou Chryssoula, Kalampokas Theodoros, Kalampokas Emmanouil, Vassiloglou Sophia, Paraskeva Anteia
a Department of Anesthesia , Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece.
b Department of Obstetrics and Gynecology , Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece.
Curr Med Res Opin. 2017 Aug;33(8):1491-1496. doi: 10.1080/03007995.2017.1321536. Epub 2017 May 24.
Local anesthetics combined with opioids are commonly used in labor epidural analgesic schemes. This study investigated if the addition of fentanyl to epidural ropivacaine can affect cervical dilation and progress of vaginal delivery.
Sixty-two nulliparous parturients were randomized to receive epidurally 8 ml ropivacaine 0.2% combined with fentanyl 20 μg (F/R-group, n = 31) or with normal saline 0.4 ml (R-group, n = 31), every hour. Rescue doses of 5 ml ropivacaine 0.2% were also administered. Measurements were performed every 60 min until full cervical dilation. The primary end-point was the time to reach 10-cm cervical dilation. Secondary outcomes were Bishop scores, mode of delivery, total ropivacaine dose, pain, and satisfaction scores (numerical scale, 0-10).
Data from 60 parturients (29 in the F/R and 31 in the R-group) were analyzed. The F/R-group had 26 vaginal deliveries (four instrumentally assisted), and three cesarean deliveries. The R-group had 27 vaginal deliveries (six instrumentally assisted) and 4 cesarean deliveries. Time to 10-cm cervical dilation did not differ between the groups (4 ± 2.4 h in the F/R-group vs 4.4 ± 2.1 h in the R-group, p = .341). The number of women remaining in the study every hour until full cervical dilation and Bishop scores for a 4-h period did not differ between the groups (p = .617). Total ropivacaine dose was comparable between the groups, but the F/R-group reported significantly lower pain (p = .01) and higher satisfaction scores (p = .001).
The addition of fentanyl to ropivacaine 0.2% solution did not affect cervical dilation and progress of the first stage of labor, but improved both analgesia and satisfaction.
局部麻醉药与阿片类药物联合常用于分娩硬膜外镇痛方案。本研究调查了在硬膜外罗哌卡因中添加芬太尼是否会影响宫颈扩张及阴道分娩进程。
62例初产妇被随机分为两组，每小时硬膜外注射8毫升0.2%罗哌卡因联合20微克芬太尼（F/R组，n = 31）或0.4毫升生理盐水（R组，n = 31）。还给予5毫升0.2%罗哌卡因的补救剂量。每60分钟进行一次测量，直至宫颈完全扩张。主要终点是达到宫颈10厘米扩张的时间。次要结局包括Bishop评分、分娩方式、罗哌卡因总剂量、疼痛和满意度评分（数字评分，0 - 10）。
分析了60例产妇的数据（F/R组29例，R组31例）。F/R组有26例阴道分娩（4例器械辅助），3例剖宫产。R组有27例阴道分娩（6例器械辅助）和4例剖宫产。两组宫颈扩张至10厘米的时间无差异（F/R组为4 ± 2.4小时，R组为4.4 ± 2.1小时，p = 0.341）。直至宫颈完全扩张，每组每小时留在研究中的产妇人数以及4小时期间的Bishop评分无差异（p = 0.617）。两组罗哌卡因总剂量相当，但F/R组报告疼痛明显较低（p = 0.01）且满意度评分较高（p = 0.001）。
在0.2%罗哌卡因溶液中添加芬太尼不影响宫颈扩张及第一产程进展，但改善了镇痛效果和满意度。
