Li Gehui, Xiao Yuci, Qi Xiaofei, Wang Hao, Wang Xiaoguang, Sun Jing, Li Yong, Li Yuantao
Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China.
Department of Food Safety, Market Supervision Administration of Shenzhen Municipality, Shenzhen, Guangdong 518040, P.R. China.
Exp Ther Med. 2020 Jul;20(1):454-460. doi: 10.3892/etm.2020.8730. Epub 2020 May 7.
Opioids and α2-agonists have been used as epidural adjuvants in local anesthetics for a long time, but the effect of the combination of opioids and α2-agonists as epidural adjuvants is not completely understood. In the present study, the combination of dexmedetomidine (Dex) and sufentanil as adjuvants to ropivacaine for epidural labor analgesia was investigated. A total of 108 parturient women receiving labor epidural analgesia were randomly divided into three groups: i) Group RD received 0.1% ropivacaine + 0.5 µg/ml Dex; ii) Group RS received 0.1% ropivacaine + 0.5 µg/ml sufentanil; and iv) Group RDS received 0.1% ropivacaine + 0.25 µg/ml Dex + 0.25 µg/ml sufentanil. Patients received a 10 ml loading dose followed by a maintenance by patient controlled epidural analgesia. The visual analog scale scores, onset time, local anesthetic requirements, motor blockage and adverse effects were recorded. Group RDS displayed an improved labor analgesia effect compared with Groups RD and RS. Group RDS displayed a shorter onset time compared with Groups RD and RS, and a reduced local anesthetic requirement compared with Group RS. The motor blockage in Groups RDS and RS was significantly lower compared with Group RD, and the incidence of pruritus in Groups RDS and RD was lower compared with Group RS. In conclusion, the combined use of 0.25 µg/ml Dex and 0.25 µg/ml sufentanil as adjuvants to 0.1% ropivacaine for epidural labor analgesia displayed an improved analgesia effect compared with the use of either 0.5 µg/ml sufentanil or 0.5 µg/ml Dex alone. The present study was registered with the Chinese Clinical Trial Registry Center on 23 February, 2018 (registration no. ChiCTR-IOR-1800014943).
长期以来，阿片类药物和α2激动剂一直被用作局部麻醉剂的硬膜外佐剂，但阿片类药物和α2激动剂联合作为硬膜外佐剂的效果尚未完全明确。在本研究中，对右美托咪定（Dex）和舒芬太尼联合作为罗哌卡因硬膜外分娩镇痛佐剂进行了研究。总共108名接受分娩硬膜外镇痛的产妇被随机分为三组：i）RD组接受0.1%罗哌卡因+0.5μg/ml Dex；ii）RS组接受0.1%罗哌卡因+0.5μg/ml舒芬太尼；iv）RDS组接受0.1%罗哌卡因+0.25μg/ml Dex+0.25μg/ml舒芬太尼。患者接受10ml负荷剂量，随后通过患者自控硬膜外镇痛进行维持。记录视觉模拟评分、起效时间、局部麻醉剂需求量、运动阻滞和不良反应。与RD组和RS组相比，RDS组的分娩镇痛效果更佳。与RD组和RS组相比，RDS组的起效时间更短，与RS组相比，局部麻醉剂需求量减少。与RD组相比，RDS组和RS组的运动阻滞明显更低，与RS组相比，RDS组和RD组的瘙痒发生率更低。总之，0.25μg/ml Dex和0.25μg/ml舒芬太尼联合作为0.1%罗哌卡因硬膜外分娩镇痛佐剂，与单独使用0.5μg/ml舒芬太尼或0.5μg/ml Dex相比，镇痛效果更佳。本研究于2018年2月23日在中国临床试验注册中心注册（注册号：ChiCTR-IOR-1800014943）。
