Peng Qinghua, Yang Zeyong, Zhang Wangping, Wu Xiaomin
Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang.
Department of Anesthesiology, International Peace Maternity and Children's Health Care Hospital, Shanghai Jiao Tong University, Shanghai.
Medicine (Baltimore). 2020 Jan;99(1):e18673. doi: 10.1097/MD.0000000000018673.
The documents on the median effective concentration of local analgesic were many in primiparas during labor analgesia. However, the studies were fewer in multiparas. To explore the analgesic requirements in multiparas during epidural labor analgesia, we investigated the median effective concentration of ropivacaine with 2 μg/mL fentanyl for epidural labor analgesia in multiparas.Sixty-two women were recruited and assigned to the primipara group and multipara group in this prospective study. All the parturients received ropivacaine combined with 2 μg/mL fentanyl for epidural labor analgesia. The concentration of ropivacaine was determined by the up and down method and an initial concentration was set as 0.1% with a 0.01% interval. Effective analgesia was defined as the visual analog scale (VAS) ≤3 within 30 minutes after epidural administration when cervical dilatation is about 2 cm. The median effective concentration of ropivacaine was calculated by the up and down sequential method. The pain intensity was assessed using VAS. Hemodynamic parameters, the labor stages, and neonatal Apgar scores were recorded. Umbilical artery blood was drawn to analyze. The side effects, if any, were also recorded.The median effective concentration of ropivacaine was 0.057% (95% confidence interval [CI], 0.051-0.064%) in primiparas during epidural labor analgesia, and 0.068% (95% CI, 0.063-0.072%) in multiparas during epidural labor analgesia, there was significant difference between the groups (P = .02).This study indicated that the median effective concentration of ropivacaine with fentanyl for epidural labor analgesia was 0.068% (95% CI, 0.063-0.072%) and increased in multiparas compared with the primiparas (www.chictr.org.cn, registration number: ChiCTR-1800016486).
关于分娩镇痛时初产妇局部镇痛药物半数有效浓度的文献很多。然而，经产妇的相关研究较少。为探讨经产妇硬膜外分娩镇痛时的镇痛需求，我们研究了罗哌卡因联合2μg/mL芬太尼用于经产妇硬膜外分娩镇痛的半数有效浓度。在这项前瞻性研究中，招募了62名女性并将其分为初产妇组和经产妇组。所有产妇均接受罗哌卡因联合2μg/mL芬太尼进行硬膜外分娩镇痛。罗哌卡因浓度采用序贯法确定，初始浓度设定为0.1%，间隔为0.01%。有效镇痛定义为硬膜外给药后30分钟内，宫颈扩张约2cm时视觉模拟评分（VAS）≤3。罗哌卡因的半数有效浓度采用序贯法计算。采用VAS评估疼痛强度。记录血流动力学参数、产程及新生儿Apgar评分。采集脐动脉血进行分析。记录所有副作用。初产妇硬膜外分娩镇痛时罗哌卡因的半数有效浓度为0.057%（95%置信区间[CI]，0.051 - 0.064%），经产妇硬膜外分娩镇痛时为0.068%（95%CI，0.063 - 0.072%），两组间差异有统计学意义（P = 0.02）。本研究表明，罗哌卡因联合芬太尼用于硬膜外分娩镇痛的半数有效浓度为0.068%（95%CI，0.063 - 0.072%），经产妇较初产妇升高（中国临床试验注册中心，注册号：ChiCTR - 1800016486）。
