Gündüz Şükrü, Eriş Yalçın Serenat, Karakoç Gökhan, Akkurt Mehmet Özgür, Yalçın Yakup, Yavuz And
University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Anesthesiology, İstanbul, Turkey.
Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Isparta, Turkey.
Turk J Obstet Gynecol. 2017 Sep;14(3):170-175. doi: 10.4274/tjod.87404. Epub 2017 Sep 30.
Effective pain relief during labor is essential to reduce maternal and perinatal morbidity arising due to pain-induced maternal sympathetic activation, and to avoid unnecessary cesarean sections performed due to maternal anxiety. Walking epidural analgesia on labor reveals lower pain scores, leading to higher maternal satisfaction with better cardiovascular and pulmonary physiology. Despite the extensive use and relative safety of bupivacaine, newer drugs such as ropivacaine have been developed as alternative agents to decrease the risk for cardiac and central nervous system toxicity.
One hundred women who requested epidural analgesia in active labor were randomly allocated into two groups; one group received 20 mL of ropivacaine 0.125% with fentanyl 50 µg and the other received 20 mL of bupivacaine 0.125% with fentanyl 50 µg. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes of both groups were compared.
There were no differences between the two study groups in the measured obstetric and neonatal outcomes. The onset time, duration of analgesia, and sensory levels were similar between the groups. Visual analog pain scale scores did not differ between the groups before analgesia or at any of the subsequent evaluation periods.
Both ropivacaine and bupivacaine provide equivalent labor analgesia with high maternal satisfaction and tolerable adverse effects in the clinically used dose range. No adverse obstetric or neonatal outcomes were observed in either group. Therefore, either drug is a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.
分娩期间有效的疼痛缓解对于降低因疼痛引起的母体交感神经激活导致的孕产妇和围产期发病率至关重要，并且可避免因产妇焦虑而进行不必要的剖宫产。分娩时行走硬膜外镇痛显示疼痛评分较低，从而使产妇满意度更高，同时具有更好的心血管和肺部生理状态。尽管布比卡因已被广泛使用且相对安全，但诸如罗哌卡因等新药已被开发作为替代药物，以降低心脏和中枢神经系统毒性风险。
100名在活跃期分娩时要求硬膜外镇痛的女性被随机分为两组；一组接受20毫升0.125%罗哌卡因加50微克芬太尼，另一组接受20毫升0.125%布比卡因加50微克芬太尼。比较两组的镇痛效果、不良反应以及产科和新生儿结局。
两个研究组在测量的产科和新生儿结局方面没有差异。两组之间的起效时间、镇痛持续时间和感觉平面相似。视觉模拟疼痛量表评分在镇痛前或任何后续评估期两组之间均无差异。
在临床使用的剂量范围内，罗哌卡因和布比卡因均可提供等效的分娩镇痛，产妇满意度高且不良反应可耐受。两组均未观察到不良产科或新生儿结局。因此，两种药物都是分娩镇痛的合理选择，并且可以在不危及母婴安全的情况下使用。
