探讨分娩镇痛中联合应用硬膜外穿刺联合硬膜外间断推注技术时，最佳程控间断硬膜外推注容量的选择：一项随机分组、分级剂量反应研究。
Determination of the Optimal Volume of Programmed Intermittent Epidural Bolus When Combined With the Dural Puncture Epidural Technique for Labor Analgesia: A Random-Allocation Graded Dose-Response Study.
机构信息
From the Department of Anesthesia, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China.
Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Anesth Analg. 2023 Dec 1;137(6):1233-1240. doi: 10.1213/ANE.0000000000006451. Epub 2023 Apr 3.
BACKGROUND
The dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques are recent innovations for labor analgesia. The optimal volume of PIEB during traditional epidural analgesia has been investigated previously but it is unknown whether these findings are applicable to DPE. This study aimed to determine the optimal volume of PIEB for effective labor analgesia after initiation of analgesia using DPE.
METHODS
Parturients requesting labor analgesia received dural puncture with a 25-gauge Whitacre spinal needle and then had analgesia initiated with 15 mL of ropivacaine 0.1% with sufentanil 0.5 μg/mL. Analgesia was maintained using the same solution delivered by PIEB with boluses given at a fixed interval of 40 minutes starting 1 hour after the completion of the initial epidural dose. Parturients were randomized to 1 of 4 PIEB volume groups: 6, 8, 10, or 12 mL. Effective analgesia was defined as no requirement for a patient-controlled or manual epidural bolus for 6 hours after the completion of the initial epidural dose or until full cervical dilation. The PIEB volumes for effective analgesia in 50% of parturients (EV50) and 90% of parturients (EV90) were determined using probit regression.
RESULTS
The proportions of parturients with effective labor analgesia were 32%, 64%, 76%, and 96% in the 6-, 8-, 10-, and 12-mL groups, respectively. The estimated values for EV50 and EV90 were 7.1 (95% confidence interval [CI], 5.9-7.9) mL and 11.3 (95% CI, 9.9-15.2) mL, respectively. There were no differences in side effects, including hypotension, nausea and vomiting, and fetal heart rate (FHR) abnormalities among groups.
CONCLUSION
Under the conditions of the study, after initiation of analgesia using DPE, the EV90 of PIEB for effective labor analgesia using ropivacaine 0.1% with sufentanil 0.5 μg/mL was approximately 11.3 mL.
背景
硬脊膜穿刺硬膜外（DPE）和程控间歇硬膜外推注（PIEB）技术是用于分娩镇痛的最新创新。先前已经研究了传统硬膜外镇痛时 PIEB 的最佳容量，但尚不清楚这些发现是否适用于 DPE。本研究旨在确定在使用 DPE 开始镇痛后进行 PIEB 的有效分娩镇痛的最佳容量。
方法
要求分娩镇痛的产妇接受 25 号 Whitacre 脊髓针硬膜穿刺，然后用 0.1%罗哌卡因和 0.5μg/mL 舒芬太尼 15mL 启动镇痛。镇痛通过以 40 分钟固定间隔给予的 PIEB 推注来维持，从初始硬膜外剂量完成后 1 小时开始。产妇随机分为 4 个 PIEB 体积组之一：6、8、10 或 12mL。有效镇痛定义为在初始硬膜外剂量完成后 6 小时内或直至完全宫颈扩张期间无需使用患者控制或手动硬膜外推注。使用概率回归确定 50%（EV50）和 90%（EV90）产妇有效镇痛的 PIEB 体积。
结果
在 6、8、10 和 12mL 组中，有效分娩镇痛的产妇比例分别为 32%、64%、76%和 96%。EV50 和 EV90 的估计值分别为 7.1（95%置信区间[CI]，5.9-7.9）mL 和 11.3（95% CI，9.9-15.2）mL。各组之间的副作用，包括低血压、恶心和呕吐以及胎心率（FHR）异常，均无差异。
结论
在本研究条件下，在使用 DPE 开始镇痛后，罗哌卡因 0.1%加舒芬太尼 0.5μg/mL 用于 PIEB 的 EV90 有效分娩镇痛约为 11.3mL。
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