Department of Anesthesiology and Pain medicine, Korea University Medical Center, Guro Hospital, Guro-Gu, Seoul, Republic of Korea.
PLoS One. 2019 Jan 11;14(1):e0209967. doi: 10.1371/journal.pone.0209967. eCollection 2019.
The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%.
To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery.
An open label randomized prospective study.
Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation. Catheters in both groups were initially tested with 3 ml of 1% lidocaine and those with any evidence of motor blockade were considered intrathecal. Sensory blockade and an 11 point numerical rating score for pain were assessed 30 minutes after administration of an epidural bolus of 10 ml of 0.22% ropivacaine with fentanyl. Successful epidural analgesia was defined as a decrease of 2 or more in the pain score and a bilateral L1-T10 sensory blockade.
Thirty-one patients were randomized to each group. The first 20 patients in each group were enrolled in a pilot study and were also included in the final analysis. One patient in the electric stimulation group was excluded owing to dural puncture by the Tuohy needle. One patient in each group demonstrated motor blockade after test dose and were considered failures. The number (% (95% confidence interval)) of successful cases were 29 out of 30 (97% (85, 100%)) in the electric stimulation group and 24 out of 31 (77% (61, 89%)) in the loss of resistance group (P = 0.053). However, analysis of only patients with absence of motor blockade revealed that 29 out of 29 (100% (92, 100%)) patients in the electric stimulation group and 24 of 29 (80% (63, 91%)) patients in the loss of resistance group had adequate analgesia (P = 0.024).
Although limited by lack of blinding, small study size and inclusion of pilot study data, this study suggests epidural electric stimulation improves the success rate of subsequent labor analgesia.
采用阻力丧失技术的硬膜外麻醉失败率为 13-23%。
研究硬膜外电刺激引导硬膜外分娩镇痛的效果。
开放标签随机前瞻性研究。
将临产妇女随机分为两组：仅使用阻力丧失技术插入硬膜外导管或使用阻力丧失技术加电刺激确认。两组的导管均先用 3ml 1%利多卡因进行测试，有任何运动阻滞迹象的导管被认为是蛛网膜下腔的。在给予 10ml 0.22%罗哌卡因加芬太尼硬膜外负荷量 30 分钟后，评估感觉阻滞和疼痛的 11 点数字评分。成功的硬膜外镇痛定义为疼痛评分降低 2 分或更多，以及双侧 L1-T10 感觉阻滞。
每组随机分配 31 名患者。每组的前 20 名患者进行了一项试点研究，并也包括在最终分析中。电刺激组的 1 名患者因 Tuohy 针刺破硬脊膜而被排除。每组各有 1 名患者在测试剂量后出现运动阻滞，被认为是失败病例。电刺激组成功的病例数为 30 例中的 29 例（97%（85%，100%）），阻力丧失组为 31 例中的 24 例（77%（61%，89%））（P=0.053）。然而，仅分析无运动阻滞的患者，电刺激组的 29 例患者（100%（92%，100%））和阻力丧失组的 24 例患者（80%（63%，91%））均有足够的镇痛效果（P=0.024）。
尽管受到缺乏盲法、研究规模小以及包括试点研究数据的限制，本研究表明硬膜外电刺激可提高随后分娩镇痛的成功率。
