Deng Jiali, Wei Changna, Liu Lin, Qian Jing, Xiao Fei, Chen Xinzhong
Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
Front Med (Lausanne). 2021 Nov 18;8:669264. doi: 10.3389/fmed.2021.669264. eCollection 2021.
Labor pain perception has been demonstrated to exhibit a circadian rhythm with lower pain scores during the day compared with the night. This study aimed to determine and compare the median effective dose (ED) of ropivacaine in parturients having epidural labor analgesia during the day vs. during the night. The study group consisted of 60 nulliparous healthy parturients who were assigned to one of two groups according to the time they requested labor analgesia: Day Group (7:01 am to 7:00 pm) and Night Group (7:01 pm to 7:00 am). A bolus of.15% ropivacaine was administered epidurally and effective analgesia was defined as the attainment of a visual analog scale (VAS) pain score ≤ 10 mm within 30 min. The dose of ropivacaine for the first parturient in each group was 18 mg. The dose for each subsequent parturient was varied with increments or decrements of 3 mg based on the response of the previous subject. The ED was calculated using up-down sequential analysis. Probit regression was used to estimate the relative mean potency of ropivacaine between groups. The ED (mean [95% CI]) of ropivacaine was lower in the Day Group (17.9 [16.5-19.4] mg) than in the Night Group (20.9 [19.2-22.7] mg) ( = 0.003). The estimate of relative potency for ropivacaine for the Night Group vs. the Day Group was 0.85 (95% CI:0.56-0.98). Under the conditions of this study, the dose requirement for epidural ropivacaine for labor analgesia was ~ 15% greater during the night than during the day. Chinese Clinical Trial Registry (No.: ChiCTR1900025269. http://www.chictr.org.cn/showprojen.aspx?proj=36993).
分娩疼痛感知已被证明呈现昼夜节律，与夜间相比，白天的疼痛评分更低。本研究旨在确定并比较白天与夜间接受硬膜外分娩镇痛的产妇中罗哌卡因的半数有效剂量（ED）。研究组由60名未生育的健康产妇组成，根据她们请求分娩镇痛的时间分为两组：白天组（上午7:01至晚上7:00）和夜间组（晚上7:01至上午7:00）。硬膜外注射一剂0.15%的罗哌卡因，有效镇痛定义为在30分钟内视觉模拟量表（VAS）疼痛评分≤10毫米。每组第一名产妇的罗哌卡因剂量为18毫克。随后每名产妇的剂量根据前一名受试者的反应以3毫克的增量或减量进行调整。使用序贯上下法分析计算ED。采用概率回归估计两组间罗哌卡因的相对平均效价。罗哌卡因的ED（均值[95%CI]）在白天组（17.9[16.5 - 19.4]毫克）低于夜间组（20.9[19.2 - 22.7]毫克）（P = 0.003）。夜间组与白天组罗哌卡因的相对效价估计值为0.85（95%CI：0.56 - 0.98）。在本研究条件下，夜间硬膜外分娩镇痛所需罗哌卡因剂量比白天大约高15%。中国临床试验注册中心（注册号：ChiCTR1900025269。http://www.chictr.org.cn/showprojen.aspx?proj = 36993）
