硬膜外穿刺硬膜外技术联合程序化间歇性硬膜外推注用于分娩镇痛的随机试验。
A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia.
作者信息
Wang Jing, Zhang Longxin, Zheng Lihua, Xiao Peihan, Wang Yuping, Zhang Li, Zhou Min
机构信息
Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Anesthesiology, Quzhou Central Hospital Affiliated to Zhejiang Chinese Medical University, Quzhou, China.
出版信息
Ann Palliat Med. 2021 Jan;10(1):404-414. doi: 10.21037/apm-20-2281.
BACKGROUND
Continuous epidural infusion (CEI) can provide analgesia during labor. The dural puncture epidural (DPE) technique is used to accelerate the onset of neuraxia anesthesia. The primary objective of this study was to compare the percentage of patients that received adequate labor analgesia following an injection of 0.08% epidural ropivacaine via the DPE and CEI techniques combined with the PIEB mode of maintenance.
METHODS
Patients who were laboring were randomly allocated to receive either CEI + PIEB or DPE + PIEB. Subjects indicated a VAS score immediately prior to epidural placement, and parturients with a VAS score of ≤50 mm were excluded. A 25-gauge needle was used for dural puncture. Analgesia was provided with 10 mL of 0.08% ropivacaine and 0.4 μg/mL of sufentanil, and was maintained at 10 mL/h in both groups with the same solution. All pumps were programmed for patient-controlled epidural analgesia (PCEA) boluses of 5 mL with a 20-minute lockout. VAS measurements were collected at 2-minute intervals for up to 20 minutes after initiation of the epidural bolus. The median time to adequate analgesia was analyzed using Kaplan-Meier curves and Cox proportional hazard models.
RESULTS
Data were collected and analyzed from 200 participants (n=100 per group). Adequate analgesia at 10 minutes was higher in the DPE + PIEB group compared to the CEI + PIEB group (DPE + PIEB =58.4% vs. CEI + PIEB =41.6%; P=0.007). The DPE + PIEB group also had a shorter median time to adequate analgesia [median (95% confidence interval (CI), 8 minutes (7-9 minutes) vs. 12 minutes (10-14 minutes)] compared to the CEI + PIEB group [hazard ratio (HR) =1.488; 95% CI, 1.105-2.002; P=0.002].
CONCLUSIONS
The percentage of parturients with adequate analgesia at 10 minutes was higher with DPE + PIEB compared to CEI + PIEB. Furthermore, the DPE + PIEB mode was associated with a faster time to a VAS score ≤30 mm.
背景
持续硬膜外输注（CEI）可在分娩期间提供镇痛。硬膜穿破硬膜外（DPE）技术用于加速神经轴麻醉的起效。本研究的主要目的是比较通过DPE和CEI技术联合PIEB维持模式注射0.08%硬膜外罗哌卡因后获得充分分娩镇痛的患者百分比。
方法
将正在分娩的患者随机分配接受CEI + PIEB或DPE + PIEB。受试者在硬膜外置管前立即表明视觉模拟评分（VAS），VAS评分≤50 mm的产妇被排除。使用25号针进行硬膜穿刺。两组均用10 mL 0.08%罗哌卡因和0.4 μg/mL舒芬太尼提供镇痛，并以相同溶液以10 mL/h维持。所有泵均设置为患者自控硬膜外镇痛（PCEA），单次推注量为5 mL，锁定时间为20分钟。在硬膜外推注开始后长达20分钟内，每隔2分钟收集一次VAS测量值。使用Kaplan-Meier曲线和Cox比例风险模型分析达到充分镇痛的中位时间。
结果
收集并分析了200名参与者的数据（每组n = 100）。与CEI + PIEB组相比，DPE + PIEB组在10分钟时的充分镇痛率更高（DPE + PIEB = 58.4% vs. CEI + PIEB = 41.6%；P = 0.007）。与CEI + PIEB组相比，DPE + PIEB组达到充分镇痛的中位时间也更短[中位值（95%置信区间（CI）），8分钟（7 - 9分钟）vs. 12分钟（10 - 14分钟）] [风险比（HR） = 1.488；95% CI，1.105 - 2.002；P = 0.002]。
结论
与CEI + PIEB相比，DPE + PIEB在10分钟时具有充分镇痛的产妇百分比更高。此外，DPE + PIEB模式与更快达到VAS评分≤30 mm的时间相关。
Zotero 插件