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[椎管内分娩镇痛:文献综述]

[Neuraxial labor analgesia: a literature review].

作者信息

Aragão Fábio Farias de, Aragão Pedro Wanderley de, Martins Carlos Alberto, Leal Karlla Fernanda Custódia Silva, Ferraz Tobias Alexandro

机构信息

Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; Universidade Federal do Maranhão (UFMA), Ciências da Saúde, São Luís, MA, Brasil; Maternidade Natus Lumine, Serviço de Anestesiologia, São Luís, MA, Brasil.

Universidade Federal do Maranhão (UFMA), Ciências da Saúde, São Luís, MA, Brasil.

出版信息

Braz J Anesthesiol. 2019 May-Jun;69(3):291-298. doi: 10.1016/j.bjan.2018.12.001. Epub 2019 Feb 15.

Abstract

The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic. The techniques were divided into the following topics: induction (epidural, combined epidural-spinal, continuous spinal, and epidural with dural puncture) and maintenance of analgesia (continuous epidural infusion, patient-controlled epidural analgesia, and intermittent epidural ). Epidural analgesia does not alter the incidence of cesarean sections or fetal prognosis, and maternal request is a sufficient indication for its initiation. The combined technique has the advantage of a faster onset of analgesia; however, patients are subject to a higher incidence of pruritus resulting from the intrathecal administration of opioids. Patient-controlled analgesia seems to be an excellent technique, reducing the consumption of local anesthetics, the number of anesthesiologist interventions, and increasing maternal satisfaction.

摘要

分娩镇痛技术的使用越来越频繁,其中神经轴技术是最常用且最有效的。分娩疼痛会带来一些对母亲和胎儿可能产生负面影响的生理后果,因此必须加以处理。本综述通过检索2016年7月至11月的PubMed数据库进行,纳入2011年至2016年期间或更早发表的英文或葡萄牙文且与该主题相关的文章。这些技术分为以下主题:镇痛诱导(硬膜外、腰麻 - 硬膜外联合、连续脊麻以及硬膜穿破后硬膜外)和镇痛维持(连续硬膜外输注、患者自控硬膜外镇痛以及间断硬膜外)。硬膜外镇痛不改变剖宫产率或胎儿预后,产妇要求是启动硬膜外镇痛的充分指征。联合技术具有镇痛起效更快的优点;然而,由于鞘内注射阿片类药物,患者瘙痒发生率较高。患者自控镇痛似乎是一种很好的技术,可减少局部麻醉药的用量、麻醉医生的干预次数并提高产妇满意度。

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[Neuraxial labor analgesia: a literature review].[椎管内分娩镇痛:文献综述]
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