Department of Anaesthesia, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Clin J Pain. 2020 Aug;36(8):612-617. doi: 10.1097/AJP.0000000000000837.
The purpose was to compare the effects of 3 different dose combinations of bupivacaine and sufentanil on the onset of analgesia and the occurrence of side effects.
One hundred sixty-nine pregnant women were randomly assigned to 3 groups: the B1S5 group received 0.1% bupivacaine+5 μg sufentanil in 15 mL; the B125S5 group received 0.125% bupivacaine+5 μg sufentanil in 15 mL; and the B1S10 group received 0.1% bupivacaine+10 μg sufentanil in 15 mL. The primary outcome was the analgesic onset time, and the secondary outcomes were mode of delivery, patient satisfaction, maternal and neonatal side effects (pruritus, hypotension, sedation, motor block, decreased fetal heart rate, fever, and interference with breastfeeding).
The median (inter-quartile range) time to achieve effective analgesia was significantly faster in the B125S5 group than in the B1S5 group (10 [11-14 {4-30}] min vs. 15 [17-20 {5-30}] min, P<0.001). There was no significant difference in the analgesia onset time between the B1S10 and B125S5 groups (10 [11-14 {4-30}] min vs. 12 [13-15 {3-30}] min, P=0.202). Pruritus, hypotension, motor block, maternal satisfaction, delivery mode, decreased fetal heart rate, total bupivacaine dose and breastfeeding scores were not significantly different among the 3 groups except the sufentanil dosage and incidence of mild drowsiness and fever (the B1S10 group had significantly higher fever than the other groups).
The B125S5 combination may be superior to the B1S5 and B1S10 combinations as an initial dose for epidural analgesia to achieve rapid effective analgesia with minimal side effects.
比较布比卡因和舒芬太尼 3 种不同剂量组合对镇痛起效时间和不良反应发生的影响。
将 169 例孕妇随机分为 3 组：B1S5 组（0.1%布比卡因+5μg 舒芬太尼，15ml）、B125S5 组（0.125%布比卡因+5μg 舒芬太尼，15ml）和 B1S10 组（0.1%布比卡因+10μg 舒芬太尼，15ml）。主要结局为镇痛起效时间，次要结局为分娩方式、患者满意度、产妇和新生儿不良反应（瘙痒、低血压、镇静、运动阻滞、胎儿心率下降、发热和影响母乳喂养）。
B125S5 组达到有效镇痛的中位（四分位间距）时间明显快于 B1S5 组（10[11-14{4-30}]min 比 15[17-20{5-30}]min，P<0.001）。B1S10 组与 B125S5 组的镇痛起效时间无显著差异（10[11-14{4-30}]min 比 12[13-15{3-30}]min，P=0.202）。瘙痒、低血压、运动阻滞、产妇满意度、分娩方式、胎儿心率下降、布比卡因总量和母乳喂养评分在 3 组之间无显著差异，除舒芬太尼剂量和轻度嗜睡及发热发生率外（B1S10 组发热发生率显著高于其他组）。
B125S5 组合作为硬膜外镇痛的起始剂量，可能优于 B1S5 和 B1S10 组合，可快速有效镇痛，且不良反应最小。
