Department of Anaesthesiology and Intensive Care, Helsinki University Hospital (HUS)/Women's Hospital, Helsinki, Finland.
Department of Obstetrics, Helsinki University Hospital (HUS)/Women's Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2019 Nov;63(10):1413-1418. doi: 10.1111/aas.13450. Epub 2019 Jul 23.
The analgesic effect on labour pain of either spinal or epidural sufentanil or fentanyl was tested in a total of 80 primiparous parturients at an early phase of the delivery. The aim of the study was to compare the level of analgesia achieved within 20 minutes.
The parturients were randomly assigned to groups receiving either spinal sufentanil (5 µg), epidural sufentanil (20 µg), spinal fentanyl (20 µg) or epidural fentanyl (100 µg), whereafter the parturients were monitored for reported pain during contraction and side effects for 30 minutes. The primary outcome was the level of analgesia achieved within 20 minutes, while the secondary outcome was the time until the administration of the first epidural bolus.
At baseline, the mean maximum pain VAS was 86 (84-89) mm. At 20 minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl or epidural fentanyl, the maximum VAS was 19 (7-31), 45 (32-59), 25 (10-39) or 52 (40-63) mm, respectively (P < .01 spin vs epid groups). There were no differences in efficacy between spinal or epidural sufentanil and fentanyl. The mean (95% CI) time to the activation of epidural analgesia was 151 (111-192), 130 (93-168), 177 (121-234) and 112 (80-143) minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl and epidural fentanyl, respectively.
In terms of a reduction of VAS score at 20 minutes, epidural sufentanil or fentanyl provide 63% and 60% of the analgesic effect of the corresponding spinal analgesia. Epidural sufentanil or fentanyl could be used in situations in which spinal/CSE administration is not possible or desired.
在分娩早期，共有 80 名初产妇接受了脊髓或硬膜外舒芬太尼或芬太尼的镇痛效果测试。本研究的目的是比较 20 分钟内达到的镇痛水平。
将产妇随机分为接受脊髓舒芬太尼（5μg）、硬膜外舒芬太尼（20μg）、脊髓芬太尼（20μg）或硬膜外芬太尼（100μg）的组，然后监测产妇在收缩期间的报告疼痛和 30 分钟内的副作用。主要结局是 20 分钟内达到的镇痛水平，次要结局是给予第一次硬膜外推注的时间。
基线时，平均最大疼痛 VAS 为 86（84-89）mm。在接受脊髓舒芬太尼、硬膜外舒芬太尼、脊髓芬太尼或硬膜外芬太尼 20 分钟后，最大 VAS 分别为 19（7-31）、45（32-59）、25（10-39）或 52（40-63）mm（P<.01 脊髓与硬膜外组）。脊髓或硬膜外舒芬太尼和芬太尼的疗效无差异。激活硬膜外镇痛的平均（95%CI）时间分别为接受脊髓舒芬太尼、硬膜外舒芬太尼、脊髓芬太尼和硬膜外芬太尼后 151（111-192）、130（93-168）、177（121-234）和 112（80-143）分钟。
就 20 分钟时 VAS 评分的降低而言，硬膜外舒芬太尼或芬太尼提供了相应脊髓镇痛的 63%和 60%的镇痛效果。在脊髓/腰麻给药不可行或不希望使用的情况下，可以使用硬膜外舒芬太尼或芬太尼。
