Khan Salman, Rizwan Umer Muhammad, Ali Zubair, Khan Muhammad A, Raza Amna, Nadeem Amjad, Hassan Muddasir Reyaz, Mumtaz Hassan
KRL General Hospital, Islamabad, Pakistan.
DHQ, Nankana Sahib, Pakistan.
Ann Med Surg (Lond). 2023 Apr 5;85(5):1475-1479. doi: 10.1097/MS9.0000000000000429. eCollection 2023 May.
It is anticipated that between 1 in 10, 000 and 1 in 30, 000 pregnancies will be affected by acute pancreatitis (AP). The authors wanted to evaluate the impact of epidural analgesia on maternal and fetal outcomes and its effectiveness in the pain treatment of obstetric patients with AP.
The period for this cohort research was from January 2022 to September 2022. Fifty pregnant women with AP symptoms were enrolled in the study. Conservative medical management was done using intravenous (i.v.) analgesics, including fentanyl and tramadol. Fentanyl was infused i.v. at a rate of 1 µg/kg every hour, while tramadol was bolused i.v. at 100 mg/kg every 8 h. Boluses of 10-15 ml of 0.1% ropivacaine were injected into the L1-L2 interspace at 2-3-h intervals to provide high lumbar epidural analgesia.
In this study, 10 patients were given an i.v. infusion of fentanyl, and 20 patients were given tramadol boluses. Epidural analgesia showed the most promising results decreasing the visual analog scale score from 9 to 2 in half of the patients. Most fetal complications were noticed in the tramadol group, including prematurity, respiratory distress, and babies requiring noninvasive ventilation.
Patients with AP during pregnancy may benefit from a new technique for simultaneous analgesia during labor and cesarean section administered via a single catheter. When AP is detected and treated during pregnancy, the mother and child benefit from pain control and recovery.
预计每10000至30000例妊娠中会有1例受急性胰腺炎（AP）影响。作者希望评估硬膜外镇痛对母婴结局的影响及其在产科AP患者疼痛治疗中的有效性。
本队列研究的时间段为2022年1月至2022年9月。50例有AP症状的孕妇纳入研究。采用静脉注射镇痛药进行保守药物治疗，包括芬太尼和曲马多。芬太尼以每小时1μg/kg的速率静脉输注，而曲马多每8小时静脉推注100mg/kg。每隔2 - 3小时在L1 - L2间隙注射10 - 15ml 0.1%罗哌卡因以提供高腰部硬膜外镇痛。
本研究中，10例患者接受芬太尼静脉输注，20例患者接受曲马多推注。硬膜外镇痛显示出最有前景的结果，半数患者的视觉模拟量表评分从9分降至2分。曲马多组出现了大多数胎儿并发症，包括早产、呼吸窘迫以及需要无创通气的婴儿。
孕期AP患者可能受益于一种通过单根导管在分娩和剖宫产期间同时进行镇痛的新技术。孕期检测并治疗AP时，母婴可从疼痛控制和恢复中获益。
