Kabi Shruti, Verma Reetu, Singh Dinesh, Singh Premraj, Agarwal Jyotsna, Kushwaha Brij Bihari, Chaudhary Ajay K, Singh Nisha
Department of Anaesthesiology and Critical Care, King George's Medical University, Lucknow, IND.
Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, IND.
Cureus. 2021 Dec 7;13(12):e20237. doi: 10.7759/cureus.20237. eCollection 2021 Dec.
Background The epidural analgesia technique is effective for labor analgesia and combinations of various local anesthetics with lipophilic opioids like fentanyl are used. However, fentanyl can cause an increased incidence of pruritus, urinary retention, nausea, vomiting, giddiness, shivering, and respiratory depression. Dexmedetomidine and clonidine are selective alpha 2 agonists with analgesic properties and have been used via the neuraxial route with local anesthetics for the same without the side effects of fentanyl. Thus, the primary objective was to assess and compare the analgesic efficacy of the two-drug combinations by the visual analog scale (VAS) score. Methods Fifty-four primigravida women were randomly allocated in two groups of 27 each and were given an initial bolus of 10 mL of 0.125% levobupivacaine with dexmedetomidine 0.5 ug/kg in Group A and with clonidine 1 μg/kg in Group B. Subsequently, each patient received a background infusion rate of 10 mL/h, a bolus dose of 5 ml, and a lock-out interval of 10 min via a patient-controlled-analgesia (PCA) pump. The blood pressure, heart rate, and severity of pain using VAS were assessed. Durations of the stages of labor, rate of instrumental delivery, and cesarean section, side effects, maternal sedation, and neonatal Apgar scores were also recorded. Results VAS scores in both the groups progressively decreased to <3 by 15 min with significant differences at five, 10, 15, and 120 min being lower in group A. Onset of analgesia and time for maximum analgesia was significantly shorter in group A. There was a significant decrease in hemodynamic parameters from baseline in both groups. The fall in heart rate was significantly greater in Group A and at almost all the time intervals after baseline, diastolic blood pressure (DBP) was also lower in group A. Maternal motor blockade scores, the intensity of maternal sedation, the incidence of maternal complications, the duration of the first and second stage of labor, the rate of instrumental delivery and cesarean section, total analgesic dose and PCA bolus requirement, and neonatal Apgar scores did not show a significant difference between the two groups. Conclusion Both dexmedetomidine and clonidine provide hemodynamically stable labor with a fall in heart rate and maternal blood pressure in the initial hours. Dexmedetomidine has the advantage of faster onset of analgesia and time for maximum analgesia.
硬膜外镇痛技术对分娩镇痛有效，且使用各种局部麻醉药与脂溶性阿片类药物（如芬太尼）的组合。然而，芬太尼可导致瘙痒、尿潴留、恶心、呕吐、头晕、寒战和呼吸抑制的发生率增加。右美托咪定和可乐定是具有镇痛特性的选择性α2激动剂，已与局部麻醉药通过神经轴途径联合使用，且无芬太尼的副作用。因此，主要目的是通过视觉模拟量表（VAS）评分评估和比较两种药物组合的镇痛效果。方法：54名初产妇被随机分为两组，每组27名。A组给予初始推注10 mL 0.125%左旋布比卡因加右美托咪定0.5 μg/kg，B组给予初始推注10 mL 0.125%左旋布比卡因加可乐定1 μg/kg。随后，每位患者通过患者自控镇痛（PCA）泵接受10 mL/h的背景输注速率、5 ml的推注剂量和10分钟的锁定间隔。评估血压、心率以及使用VAS评估的疼痛严重程度。记录产程各阶段的持续时间、器械助产率和剖宫产率、副作用、产妇镇静情况以及新生儿阿普加评分。结果：两组的VAS评分在15分钟时均逐渐降至<3，在5、10、15和120分钟时存在显著差异，A组更低。A组的镇痛起效时间和最大镇痛时间显著更短。两组的血流动力学参数均较基线有显著下降。A组心率下降幅度显著更大，且在基线后的几乎所有时间间隔，A组的舒张压（DBP）也更低。产妇运动阻滞评分、产妇镇静强度、产妇并发症发生率、第一和第二产程持续时间、器械助产率和剖宫产率、总镇痛剂量和PCA推注需求量以及新生儿阿普加评分在两组之间均无显著差异。结论：右美托咪定和可乐定在最初几小时内均可提供血流动力学稳定的分娩镇痛，同时伴有心率和产妇血压下降。右美托咪定具有镇痛起效更快和最大镇痛时间更短的优势。
