Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Int J Obstet Anesth. 2022 Aug;51:103571. doi: 10.1016/j.ijoa.2022.103571. Epub 2022 Jul 2.
In this randomized, blinded study, we evaluated the effects of different programmed intermittent epidural bolus (PIEB) volumes for labor analgesia on the incidence of breakthrough pain and other analgesic outcomes.
Nulliparous women with term cephalic singleton pregnancies who requested labor analgesia had epidural analgesia initiated with 10 mL 0.1% ropivacaine with sufentanil 0.3 μg/mL. The pump was programmed to deliver a 4, 6 or 8 mL bolus every 45 min (groups 4, 6 or 8, respectively). The primary outcome was the incidence of breakthrough pain, defined as inadequate analgesia after two patient-controlled epidural analgesia administrations in a 20-min period. Secondary outcomes included ropivacaine consumption, time of the first patient-controlled epidural analgesia request, duration of the second stage of labor, and incidence of motor block.
Among 210 women randomly allocated the incidence of breakthrough pain was 34.9%, 19.7%, and 13.1%, for groups 4, 6 and 8, respectively (P=0.011). The incidence of breakthrough pain in group 8 was lower than in group 4 (P=0.006). The median (interquartile range) hourly ropivacaine consumption was 8.2 mg/h (7.1-11.3), 10.4 mg/h (9.2-13.0), and 12.0 mg/h (11.2-13.8) in groups 4, 6 and 8, respectively (P <0.001). Group 8 had a longer duration of effective analgesia and longer second stage of labor than group 4. There was no significant difference between groups in the incidence of motor block.
The larger PIEB volumes were preferred for epidural labor analgesia compared with a smaller volume because of improved analgesia without clinically significant increases in adverse effects.
在这项随机、盲法研究中，我们评估了不同程控间歇硬膜外推注（PIEB）容量用于分娩镇痛对爆发痛发生率和其他镇痛效果的影响。
足月头位单胎妊娠初产妇要求分娩镇痛，给予负荷量 10ml0.1%罗哌卡因复合 0.3μg/ml 舒芬太尼行硬膜外镇痛。将泵设置为每 45 分钟推注 4、6 或 8ml （分别为组 4、6 和 8）。主要结局是爆发痛的发生率，定义为在 20 分钟内两次患者自控硬膜外镇痛后镇痛不足。次要结局包括罗哌卡因用量、首次患者自控硬膜外镇痛请求时间、第二产程时间和运动阻滞发生率。
210 例随机分配的产妇中，组 4、6 和 8 爆发痛的发生率分别为 34.9%、19.7%和 13.1%（P=0.011）。组 8 的爆发痛发生率低于组 4（P=0.006）。组 4、6 和 8 的每小时罗哌卡因用量中位数（四分位间距）分别为 8.2mg/h（7.1-11.3）、10.4mg/h（9.2-13.0）和 12.0mg/h（11.2-13.8）（P<0.001）。组 8 的有效镇痛时间和第二产程均长于组 4。各组的运动阻滞发生率无显著差异。
与小容量相比，较大的 PIEB 容量更有利于硬膜外分娩镇痛，因为其镇痛效果改善而不良反应无明显增加。
