Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
J Clin Anesth. 2017 Dec;43:6-10. doi: 10.1016/j.jclinane.2017.09.003. Epub 2017 Sep 13.
OBJECTIVE: To study the role of intravenous (i.v.) dexamethasone as an analgesic adjunct in labor analgesia. DESIGN: Double-blinded randomized controlled trial. SETTING: Labor analgesia in a tertiary-care teaching hospital. PATIENTS: Eighty consenting ASA I-II parturients, age>18year, nulliparous, single gestation, cephalic presentation at ≥36 wk. of gestation, in early spontaneous labor (cervical dilatation≤5cm) requesting epidural analgesia. INTERVENTIONS: The patients were randomized to two groups. The Dexa group received 8mg of dexamethasone i.v. in 50ml normal saline approximately 45min before the procedure. Placebo group patients received 50ml normal saline only. All patients underwent epidural labor analgesia per hospital protocol. After an initial bolus, they received continuous background infusion of 5ml/h of 0.1% of levobupivacaine with 2μg/ml of fentanyl, with the provision of patient controlled boluses of 5ml of the same drug combination with a lockout interval of 12min if needed. MEASUREMENTS: Primary outcome measure: hourly average consumption of neuraxially administered levobupivacaine-fentanyl combination. Secondary outcomes and observations: pain score, maternal satisfaction, sensory and motor block characteristics, hemodynamic parameters of mother, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores at 1 and 5min, and adverse effects. MAIN RESULTS: Average hourly drug consumption was significantly lower in Dexa group as compared to Placebo group (10.34±1.79ml/h vs. 11.34±1.83ml/h; mean difference 1.007, 95% CI 0.199-1.815; P=0.015). The median number of bolus doses was 4 (interquartile-range [IQR] 3-5.75) and 5 (IQR 3-6) in the Dexa and Placebo groups, respectively (P=0.162). There was no significant difference between groups with regard to pain scores, maternal satisfaction and hemodynamics, mode of delivery, and adverse effects. CONCLUSIONS: I.v. dexamethasone significantly decreased hourly average drug consumption of levobupivacaine-fentanyl combination through the epidural route, demonstrating the epidural drug dose sparing effect during labor analgesia.
目的：研究静脉（i.v.）地塞米松作为分娩镇痛辅助药物的作用。
设计：双盲随机对照试验。
地点：三级教学医院的分娩镇痛。
患者：80 名同意的 ASA I-II 产妇，年龄>18 岁，初产妇，单胎妊娠，36 周以上足月，产程早期自发（宫颈扩张≤5cm）要求硬膜外镇痛。
干预措施：患者随机分为两组。地塞米松组在操作前约 45 分钟静脉注射 8mg 地塞米松于 50ml 生理盐水。安慰剂组患者仅接受 50ml 生理盐水。所有患者均按医院方案接受硬膜外分娩镇痛。初始推注后，给予 0.1%左布比卡因和 2μg/ml 芬太尼的持续背景输注 5ml/h，并根据需要提供 5ml 相同药物组合的患者自控推注，锁定间隔为 12min。
测量：主要结局测量：每小时鞘内给予左布比卡因-芬太尼组合的平均消耗量。次要结局和观察指标：疼痛评分、产妇满意度、感觉和运动阻滞特征、母亲的血液动力学参数、胎儿心率、第二产程持续时间、分娩方式、1 分钟和 5 分钟时的 Apgar 评分以及不良反应。
主要结果：与安慰剂组相比，地塞米松组的平均每小时药物消耗明显降低（10.34±1.79ml/h 与 11.34±1.83ml/h；平均差异 1.007，95%CI 0.199-1.815；P=0.015）。地塞米松组和安慰剂组的推注剂量中位数分别为 4（四分位距 [IQR] 3-5.75）和 5（IQR 3-6）（P=0.162）。两组在疼痛评分、产妇满意度和血液动力学、分娩方式以及不良反应方面无显著差异。
结论：静脉注射地塞米松通过硬膜外途径显著降低了左布比卡因-芬太尼联合用药的每小时平均药物消耗量，证明了硬膜外药物剂量节约效应在分娩镇痛中的作用。
Korean J Anesthesiol. 2018-10
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