Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
Am J Obstet Gynecol. 2021 Dec;225(6):B2-B8. doi: 10.1016/j.ajog.2021.08.031. Epub 2021 Aug 28.
Pain is a complex phenomenon that involves more than a simple physical response to external stimuli. In maternal-fetal surgical procedures, fetal analgesia is used primarily to blunt fetal autonomic responses and minimize fetal movement. The purpose of this Consult is to review the literature on what is known about the potential for fetal awareness of pain and to discuss the indications for and the risk-benefit calculus involved in the use of fetal anesthesia and analgesia. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that fetal paralytic agents be considered in the setting of intrauterine transfusion, if needed, for the purpose of decreasing fetal movement (GRADE 2C); (2) although the fetus is unable to experience pain at the gestational age when procedures are typically performed, we suggest that opioid analgesia should be administered to the fetus during invasive fetal surgical procedures to attenuate acute autonomic responses that may be deleterious, avoid long-term consequences of nociception and physiological stress on the fetus, and decrease fetal movement to enable the safe execution of procedures (GRADE 2C); and (3) due to maternal risk and a lack of evidence supporting benefit to the fetus, we recommend against the administration of fetal analgesia at the time of pregnancy termination (GRADE 1C).
疼痛是一种复杂的现象，不仅仅是对外部刺激的简单物理反应。在母胎手术中，胎儿镇痛主要用于抑制胎儿自主反应和最小化胎儿运动。本次咨询的目的是回顾有关胎儿感知疼痛的潜在可能性的文献，并讨论使用胎儿麻醉和镇痛的适应证和风险效益分析。母胎医学学会的建议如下：(1) 我们建议，如果需要，在宫内输血的情况下考虑使用胎儿麻痹剂，以减少胎儿运动（GRADE 2C）；(2) 虽然在进行手术的妊娠阶段胎儿无法体验疼痛，但我们建议在侵入性胎儿手术期间向胎儿给予阿片类镇痛剂，以减轻可能有害的急性自主反应，避免伤害感受和生理应激对胎儿的长期影响，并减少胎儿运动，以确保手术的安全进行（GRADE 2C）；(3) 由于母体风险和缺乏对胎儿有益的证据，我们建议在终止妊娠时不给予胎儿镇痛（GRADE 1C）。
