Yang Meijuan, Wang Luyang, Chen Hong, Tang Yuwen, Chen Xinzhong
Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, No. 2 Xueshi Road, Hangzhou, Zhejiang 310006, China.
Pain Res Manag. 2019 Mar 3;2019:9054538. doi: 10.1155/2019/9054538. eCollection 2019.
Single dose of epidural hydromorphone has been introduced to serve as an alternative method for postcesarean section analgesia. However, optimal dose of epidural hydromorphone remains unknown. Hence, we evaluated and compared the analgesic and adverse effects of postoperative different doses of epidural hydromorphone coadministered with ropivacaine after cesarean section.
Eighty term parturients with elective cesarean section under epidural anesthesia were allocated into four groups. Epidural analgesia was administered with an epidural bolus of either 0 mg (group H0), or 0.2 mg (group H1), or 0.4 mg (group H2), or 0.6 mg (group H3) hydromorphone coadministered with ropivacaine. The primary outcome was the visual analogue pain scores (VAPSs) and rescue opioid consumption (PCIA with sulfentanil) in 24 hours. Adverse effects such as respiratory depression, pruritus, nausea, and vomiting were recorded.
The VAPSs of group H1 at 2, 4, 6, 12 h and 24 h after surgery was similar to group H0. The VAPSs of group H2 at 4 and 6 h postoperatively were significantly decreased when compared to group H0. But, the VAPSs of group H2 at 2, 12, and 24 h postoperatively were similar to those of group H0. The VAPSs of group H3 at 4, 6, 12 h, and 24 h after surgery were significantly decreased when compared to those of group H0. The total sulfentanil consumption in 24 hours was 90 ± 26 g in group H0, 75 ± 29 g in group H1, 54 ± 32 g in group H2, and 15 ± 16 g in group H0. Adverse effects were comparable in the four groups.
Epidural administration of 0.6 mg hydromorphone coadministered with ropivacaine after cesarean section provided satisfactory pain relief with less sulfentanil consumption. This trial is registered with ChiCTR-IPR-16010026.
单次硬膜外注射氢吗啡酮已被引入作为剖宫产术后镇痛的替代方法。然而，硬膜外注射氢吗啡酮的最佳剂量仍不清楚。因此，我们评估并比较了剖宫产术后不同剂量硬膜外氢吗啡酮与罗哌卡因联合使用的镇痛效果及不良反应。
80例择期硬膜外麻醉下行剖宫产术的足月产妇被分为四组。硬膜外镇痛分别给予0毫克（H0组）、0.2毫克（H1组）、0.4毫克（H2组）或0.6毫克（H3组）氢吗啡酮与罗哌卡因的硬膜外推注剂量。主要观察指标为术后24小时的视觉模拟疼痛评分（VAPS）和补救性阿片类药物用量（舒芬太尼自控静脉镇痛）。记录呼吸抑制、瘙痒、恶心和呕吐等不良反应。
H1组术后2、4、6、12小时和24小时的VAPS与H0组相似。H2组术后4小时和6小时的VAPS与H0组相比显著降低。但是，H2组术后2、12和24小时的VAPS与H0组相似。H3组术后4、6、12小时和24小时的VAPS与H0组相比显著降低。H0组24小时舒芬太尼总用量为90±26微克，H1组为75±29微克，H2组为54±32微克，H3组为15±16微克。四组的不良反应相当。
剖宫产术后硬膜外给予0.6毫克氢吗啡酮与罗哌卡因联合使用可提供满意的镇痛效果，且舒芬太尼用量较少。本试验已在中国临床试验注册中心注册，注册号为ChiCTR-IPR-16010026。
