Bhatia Upasna, Soni Premal, Khilji Udit, Trivedi Yamini N
Department of Anaesthesia, AMC MET Medical College and LG Hospital, Ahmedabad, Gujarat, India.
Department of Obstetrics and Gynecology, AMC MET Medical College and LG Hospital, Ahmedabad, Gujarat, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):651-655. doi: 10.4103/0259-1162.204204.
Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, "episiotomy infiltration" becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1 day of postpartum period.
We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection.
Majority of the patients, 94.2% in our study, had no idea about labor analgesia, and only 2.5% of all the patients expressed their interest to deliver without suffering from labor pains. One hundred and twenty pregnant female patients scheduled for full-term vaginal delivery were assigned into lignocaine and lignocaine-clonidine group according to infiltration they received. Pain scoring using visual analog scale and maternal satisfaction scale was monitored. At the end of the research project, the data were compiled and analyzed using appropriate statistical tests.
Duration of analgesia after episiotomy during sitting, walking, and squatting was 22.7 ± 1.32, 21.73 ± 1.47, and 19.875 ± 1.48 h in clonidine + lignocaine group and 6.06 ± 1.26, 5.33 ± 1.18, and 4.01 ± 1.28 h in lignocaine only group, respectively, which was highly statistically significant < 0001.
Clonidine when added to 2% lignocaine infiltration in episiotomy improves the quality and significantly enhances the duration of analgesia.
尽管硬膜外分娩镇痛有诸多优点,但尚未被完全接受。很多时候,孕妇未进行产前检查就到了医院,此时,“会阴切开浸润麻醉”成为阴道分娩的理想方法。会阴切开术后最重要的问题之一是产后第1天会阴部剧痛。
我们比较了1μg/kg可乐定作为辅助药物加入20mg/ml利多卡因沿会阴切开切口浸润麻醉,通过单次注射在不同活动中延长镇痛持续时间和提高镇痛质量的效果。
在我们的研究中,大多数患者(94.2%)对分娩镇痛一无所知,所有患者中只有2.5%表示希望在无分娩疼痛的情况下分娩。120例计划进行足月阴道分娩的孕妇根据所接受的浸润麻醉被分为利多卡因组和利多卡因-可乐定组。采用视觉模拟评分法进行疼痛评分,并监测产妇满意度。在研究项目结束时,使用适当的统计检验对数据进行汇总和分析。
可乐定+利多卡因组在坐、行走和蹲时会阴切开术后的镇痛持续时间分别为22.7±1.32、21.73±1.47和19.875±1.48小时,仅利多卡因组分别为6.06±1.26、5.33±1.18和4.01±1.28小时,差异具有高度统计学意义(P<0.001)。
在会阴切开术中,可乐定加入2%利多卡因浸润麻醉可提高镇痛质量并显著延长镇痛持续时间。