Wahdan Amr Samir, El-Sakka Ahmed Ibrahim, Gaafar Hassan Mostafa Ismail
Department of Anaesthesiology, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Indian J Anaesth. 2017 Jul;61(7):556-561. doi: 10.4103/ija.IJA_149_17.
Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia.
A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Forty females were included randomly in either Group L (received intrathecal levobupivacaine 0.25% in 2 mL) or Group LD (received intrathecal levobupivacaine 0.25% combined with dexamethasone 4 mg in 2 mL). The primary outcome was the duration of spinal analgesia. Secondary outcomes included the total dose of epidural local anaesthetic given, time to delivery, neonatal outcome and adverse effects.
The duration of spinal analgesia was significantly longer in the LD group compared with L group (80.5 ± 12.4 min vs. 57.1 ± 11.5 min, respectively; < 0.001). In Group LD compared with Group L, time from spinal analgesia to delivery was significantly lower (317.4 ± 98.9 min vs. 372.4 ± 118.8 min, respectively; = 0.027), and total epidural levobupivacaine consumption was significantly lower (102.4 ± 34.8 mg vs. 120.1 ± 41.9 mg, respectively; = 0.027). The two groups were comparable with respect to characteristics of sensory and motor block, haemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects.
Intrathecal dexamethasone plus levobupivacaine prolongs the duration of spinal analgesia during combined spinal-epidural CSE for labour analgesia.
区域镇痛常用于缓解分娩疼痛，辅助用药可延长镇痛时间。本随机对照试验的目的是评估鞘内注射左旋布比卡因联合地塞米松用于分娩镇痛的疗效。
本研究共纳入80名女性，均为初产妇，行阴道分娩，宫颈扩张≥4 cm且宫颈管消退50%及以上。40名女性被随机纳入L组（接受2 mL 0.25%鞘内左旋布比卡因）或LD组（接受2 mL 0.25%鞘内左旋布比卡因联合4 mg地塞米松）。主要结局是脊髓镇痛的持续时间。次要结局包括硬膜外局部麻醉药的总用量、分娩时间、新生儿结局及不良反应。
LD组脊髓镇痛的持续时间显著长于L组（分别为80.5±12.4分钟和57.1±11.5分钟；P<0.001）。与L组相比，LD组从脊髓镇痛到分娩的时间显著缩短（分别为第317.4±98.9分钟和372.4±118.8分钟；P = 0.027），硬膜外左旋布比卡因的总用量显著降低（分别为102.4±34.8 mg和120.1±41.9 mg；P = 0.027）。两组在感觉和运动阻滞特征、血流动力学参数、疼痛评分、新生儿结局及不良反应发生率方面具有可比性。
在腰麻-硬膜外联合阻滞（CSE）用于分娩镇痛时，鞘内地塞米松加左旋布比卡因可延长脊髓镇痛的持续时间。
