Wang Sheng-You, He Yan, Zhu Hai-Juan, Han Bo
Department of Anesthesiology, Hefei Maternal and Child Health Care Hospital, Hefei 230001, Anhui Province, China.
Department of Anesthesiology, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China.
World J Clin Cases. 2022 Jul 16;10(20):6890-6899. doi: 10.12998/wjcc.v10.i20.6890.
Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys. The dural puncture epidural (DPE) technique provides faster and more effective analgesia for labor, but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.
To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.
Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia (EA) groups. A 25-G spinal needle was used for dural puncture a 19-G epidural needle. The patients in the two groups were injected with 5 mL of 2% lidocaine followed by 15 mL of a mixture of 1% lidocaine + 0.5% ropivacaine as the epidural dosage. The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.
A total of 115 women were included (EA: 57, DPE: 58). The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group (14.7 min 16.6 min; 95% confidence interval, 13.9 to 15.4 15.8 to 17.4; = 0.001). The cranial sensory block level was significantly higher at 5, 10, and 15 min after the initial dose in the DPE group than in the EA group ( < 0.05). The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point ( < 0.05). Adverse effects and neonatal outcomes were comparable between the two groups ( > 0.05).
The DPE technique provided higher-quality anesthesia than the EA technique, with a rapid onset of surgical anesthesia, better cranial and sacral sensory block spread and a higher motor block degree, without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.
再次剖宫产手术时间比初次剖宫产更长，内脏牵拉更严重。腰硬联合麻醉（DPE）技术可为分娩提供更快、更有效的镇痛，但尚无充分证据表明其是否适用于接受再次剖宫产的产妇。
确定DPE麻醉技术在接受再次剖宫产患者中的有效性和安全性。
将接受再次剖宫产的患者随机分为DPE组和硬膜外麻醉（EA）组。使用25G腰穿针进行硬膜穿刺，而非19G硬膜外针。两组患者均先注射5mL 2%利多卡因，随后注射15mL 1%利多卡因+0.5%罗哌卡因混合液作为硬膜外用药剂量。主要观察指标为感觉阻滞至T6皮节水平的起效时间以及感觉和运动阻滞程度。
共纳入115名女性（EA组57例，DPE组58例）。DPE组感觉阻滞至T6水平的平均时间显著短于EA组（14.7分钟对16.6分钟；95%置信区间，13.9至15.4对15.8至17.4；P=0.001）。DPE组在首次给药后5、10和15分钟时的颅部感觉阻滞水平显著高于EA组（P<0.05）。DPE组在各时间点骶部感觉阻滞水平显著更高，改良 Bromage 评分显著更低（P<0.05）。两组间不良反应和新生儿结局相当（P>0.05）。
DPE技术比EA技术提供了更高质量的麻醉，手术麻醉起效迅速，颅部和骶部感觉阻滞扩散更好，运动阻滞程度更高，且不增加再次剖宫产患者母体或胎儿副作用的发生率。
