Fierro Giulia, Milan Barbara, Buelli Elena, Bugada Dario, Casarotta Erika, Rizzo Francesco, Ongaro Laura, Gritti Paolo, Previdi Fabio, Lorini Ferdinando Luca
Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy.
Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, Ancona, 60020, Italy.
J Anesth Analg Crit Care. 2024 Jul 8;4(1):41. doi: 10.1186/s44158-024-00177-z.
Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.
We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating "not satisfied" to 5, denoting "completely satisfied"), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed.
The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.
Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.
在引产终止妊娠过程中进行有效的疼痛管理至关重要。然而，迄今为止，尚未确定有效的治疗方法。本研究的主要目的是通过比较初产妇和经产妇，来测量舒芬太尼舌下片系统在终止妊娠时的镇痛效果及患者满意度。次要目的是通过报告任何副作用或不良事件来描述安全性概况，并确定是否需要急救治疗。
我们进行了一项观察性、回顾性、单中心研究，纳入了48名女性。检索用于分析的数据包括舌下舒芬太尼的总剂量和每小时剂量、使用5分制评分量表（范围从1表示“不满意”到5表示“完全满意”）对疼痛管理满意度的评估、副作用和不良事件的发生情况以及急救镇痛药物的使用比例。对两组之间的分类变量和数值变量进行比较，并进行相关性分析。
所需舒芬太尼的中位总剂量为60微克。与经产妇相比，初产妇需要更高剂量的舒芬太尼（105微克对45微克；P = 0.01）。此外，通过设备使用时间间接测量，她们的产程更长（625分钟对165分钟；P = 0.05）。关于满意度，40名患者（83.4%）表示满意或完全满意，而只有8名患者（16.6%）表示不满意。经产妇的满意度高于初产妇（P = 0.03）。未报告不良事件，最常见的副作用是恶心和呕吐（31.2%）。4名患者（12%）因镇痛不足需要使用对乙酰氨基酚，只有1名患者需要改用静脉注射吗啡。
舌下舒芬太尼对初产妇和经产妇均有效，且副作用最小。因此，舌下舒芬太尼可被视为引产终止妊娠时镇痛的有效策略。
