硬膜外分娩镇痛-芬太尼剂量与母乳喂养成功：一项随机临床试验。

Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.

作者信息

Lee Amy I, McCarthy Robert J, Toledo Paloma, Jones Mary Jane, White Nancy, Wong Cynthia A

机构信息

From the Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, Texas (A.I.L.); Department of Anesthesiology (R.J.M., P.T., M.J.J.) and Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois (R.J.M., P.T.); Department of Nursing, Northwestern Memorial Hospital Chicago, Illinois (N.W.); and Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.).

出版信息

Anesthesiology. 2017 Oct;127(4):614-624. doi: 10.1097/ALN.0000000000001793.

DOI:10.1097/ALN.0000000000001793

PMID:28926440

Abstract

BACKGROUND

Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia.

METHODS

The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured.

RESULTS

A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum.

CONCLUSIONS

Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

摘要

背景

母乳喂养是一个重要的公共卫生问题。据报道，用于分娩镇痛的硬膜外芬太尼累积高剂量与母乳喂养的早期终止有关。我们检验了这样一个假设，即用于分娩镇痛的硬膜外芬太尼累积剂量会对母乳喂养的成功产生不利影响。

方法

该研究是一项针对孕周大于38周、计划进行母乳喂养、曾成功母乳喂养过前一个婴儿且接受了椎管内分娩镇痛的经产妇的随机、双盲、对照试验。参与者被随机分配接受三种用于分娩镇痛的硬膜外维持溶液之一（布比卡因1毫克/毫升、布比卡因0.8毫克/毫升加芬太尼1微克/毫升、或布比卡因0.625毫克/毫升加芬太尼2微克/毫升）。主要结局是产后6周进行母乳喂养的女性比例。测量了分娩时母体和脐静脉血中芬太尼和布比卡因的浓度。

结果

共有345名女性被随机分组，305名有完整数据用于分析。接受硬膜外芬太尼0、1和2微克/毫升的组中，产后6周母乳喂养的频率分别为97%、98%和94%（P = 0.34）。在产后6周停止母乳喂养的女性和仍在母乳喂养的女性之间，芬太尼累积剂量（差异：37微克[差异的95%置信区间，-58至79微克]，P = 0.28）以及母体和脐带静脉血中芬太尼和布比卡因的浓度并无差异。