Khaled Gaballah M, Sabry Abdallah I
Department of Anaesthesiology, Faculty of Medicine, Menoufia University, Egypt.
Indian J Anaesth. 2020 Feb;64(2):109-117. doi: 10.4103/ija.IJA_572_19. Epub 2020 Feb 4.
Although intrathecal analgesia is an effective option during labour, there is a need to establish sustainable and assured analgesia during the entire labour process. We aimed to assess the effect of adding dexmedetomidine, fentanyl or morphine to low-dose bupivacaine-dexamethasone for intrathecal labour analgesia in multiparous women.
This was a triple-blind, randomised controlled trial that included 140 multiparous women. Eligible women were randomly allocated to have intrathecal bupivacaine-dexamethasone with dexmedetomidine (group D), fentanyl (group F), morphine (group M) or saline (placebo) (group C). The duration of analgesia, intrathecal block characteristics and maternal and foetal outcomes were assessed and analysed.
The longest analgesia duration and S1 regression time was recorded in group D followed by groups M, F and C, respectively, with statistical significance between all of them ( < 0.001). The shortest analgesia onset time and the highest sensory levels were recorded in group D followed by group F then group M with statistical significance between all of them ( < 0.001 and 0.003, respectively). Visual analogue scale values were comparable among groups M, F and D ( > 0.05) at most of the measurement time points and at the peak of the last uterine contraction before delivery while being significantly lower than those in group C ( < 0.001). However, there were similar motor block characteristics and normal neonatal outcomes in all groups.
In comparison to morphine and fentanyl, dexmedetomidine addition to intrathecal bupivacaine-dexamethasone significantly prolonged the duration and accelerated the onset of labour analgesia, with a good maternal and neonatal outcome.
尽管鞘内镇痛是分娩期间的一种有效选择，但仍需要在整个分娩过程中建立可持续且可靠的镇痛方法。我们旨在评估在低剂量布比卡因 - 地塞米松中添加右美托咪定、芬太尼或吗啡用于经产妇鞘内分娩镇痛的效果。
这是一项三盲随机对照试验，纳入了140名经产妇。符合条件的女性被随机分配接受鞘内注射布比卡因 - 地塞米松加右美托咪定（D组）、芬太尼（F组）、吗啡（M组）或生理盐水（安慰剂）（C组）。评估并分析镇痛持续时间、鞘内阻滞特征以及母婴结局。
D组记录到最长的镇痛持续时间和S1消退时间，其次分别是M组、F组和C组，各组之间具有统计学意义（<0.001）。D组记录到最短的镇痛起效时间和最高的感觉平面，其次是F组，然后是M组，各组之间具有统计学意义（分别为<0.001和0.003）。在大多数测量时间点以及分娩前最后一次子宫收缩峰值时，M组、F组和D组的视觉模拟量表值相当（>0.05），但显著低于C组（<0.001）。然而，所有组的运动阻滞特征相似，新生儿结局正常。
与吗啡和芬太尼相比，在鞘内布比卡因 - 地塞米松中添加右美托咪定可显著延长分娩镇痛的持续时间并加快起效时间，母婴结局良好。
