Department of anaesthesiology, Central hospital of Seinäjoki, Seinäjoki, Finland.
Department of anaesthesiology, Helsinki University Central Hospital, Women's hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2023 Sep;67(8):1079-1084. doi: 10.1111/aas.14282. Epub 2023 May 22.
Single shot spinal (SSS) provides effective analgesia for multiparous parturients during advanced labour. Its utility in early labour or primiparous parturients may be limited by the insufficient duration of action. Regardless, SSS may offer a reasonable labour analgesia option in certain clinical scenarios. In this retrospective study, we analyse the failure rate of SSS analgesia by assessing pain after the SSS and by determining the need for additional analgesic interventions in primiparous or early-stage multiparous parturients compared to multiparous parturients in advanced labour (cervix ≥6 cm).
Following institutional ethical board approval, the patient files of all parturients receiving SSS analgesia during a 12-month period in a single centre were analysed for any recorded notes regarding recurrent pain or subsequent analgesia interventions (a new SSS, epidural, pudendal or paracervical bloc) as a marker for insufficient analgesia.
A total of 88 primiparous and 447 multiparous parturients (cervix <6 cm: N = 131; cervix ≥6 cm: N = 316) received SSS analgesia. The odds ratio for the insufficient duration of analgesia was 1.94 (1.08-3.48) in primiparous and 2.08 (1.25-3.46) in early-stage multiparous parturients compared to advanced multiparous labour (p < .01). Primiparous and early-stage multiparous parturients were also 2.20 (1.15-4.20) and 2.61 (1.50-4.55) times more likely, respectively, to receive new peripheral and/or neuraxial analgesic interventions during delivery (p < .01).
SSS appears to provide adequate labour analgesia for the majority of parturients in whom it is used, including nulliparous and early-stage multiparous parturients. It remains a reasonable option in certain clinical scenarios, including resource-limited settings where epidural analgesia is unavailable.
单次脊髓麻醉（SSS）可为活跃期的多产妇提供有效的分娩镇痛。但由于作用持续时间不足，其在潜伏期或初产妇中的应用可能受到限制。无论如何，SSS 可能为某些临床情况下提供合理的分娩镇痛选择。在这项回顾性研究中，我们通过评估 SSS 后疼痛以及与活跃期（宫颈≥6cm）多产妇相比，初产妇或潜伏期多产妇对 SSS 镇痛的需求，来分析 SSS 镇痛失败率。
在获得机构伦理委员会批准后，我们对单中心在 12 个月内接受 SSS 镇痛的所有产妇的病历进行分析，以查找任何关于复发疼痛或后续镇痛干预（新的 SSS、硬膜外、阴部或子宫旁阻滞）的记录，以作为镇痛不足的标志。
共 88 名初产妇和 447 名多产妇（宫颈<6cm：N=131；宫颈≥6cm：N=316）接受了 SSS 镇痛。与活跃期多产妇分娩相比，初产妇和潜伏期多产妇镇痛作用持续时间不足的比值比分别为 1.94（1.08-3.48）和 2.08（1.25-3.46）（p<.01）。初产妇和潜伏期多产妇在分娩时更有可能接受新的外周和/或神经轴镇痛干预，其比值比分别为 2.20（1.15-4.20）和 2.61（1.50-4.55）（p<.01）。
SSS 似乎为大多数使用它的产妇提供了足够的分娩镇痛，包括初产妇和潜伏期多产妇。在某些临床情况下，它仍然是一种合理的选择，包括在资源有限且无法提供硬膜外镇痛的情况下。
