Stamatakis Emmanouil, Panagouli Konstantina, Hadzilia Sophia, Pavlidis Michail, Skandalou Vassiliki, Loukeri Anastasia, Saiti Athanasia, Valsamidis Dimitrios
Department of Anesthesiology, Alexandra General Hospital of Athens, Athens, GRC.
Second Department of Anesthesiology, Attikon University General Hospital, Athens, GRC.
Cureus. 2024 Jul 1;16(7):e63564. doi: 10.7759/cureus.63564. eCollection 2024 Jul.
Objective The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either by bolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs. Methods A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns. Results All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed by the obstetrician. Conclusion Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.
目的 分娩期间疼痛管理的金标准是硬膜外镇痛，可通过两种不同方式向产妇给药，即单次推注或持续输注含阿片类药物的局部麻醉溶液。最近，通过泵进行的程序化间歇性硬膜外推注（PIEBs）作为一种副作用最小的非常有效的方法越来越受欢迎。本研究的目的是使用PIEBs评估两种不同方案（均为0.1%或0.2%罗哌卡因加2μg/ml芬太尼）之间的最佳罗哌卡因浓度，该浓度可在运动阻滞程度最小的情况下提供满意的镇痛效果。方法 于2020年3月至2022年3月进行了一项前瞻性随机对照研究。将两种不同浓度的0.1%和0.2%罗哌卡因通过PIEBs平均分配给两组产妇，如有需要，额外给予患者自控硬膜外急救推注。我们的主要终点是通过改良Bromage量表（MBS）评估的运动阻滞。我们还记录了视觉模拟量表（VAS）评分、心率、血压、局部麻醉药总消耗量、产程和分娩方式以及新生儿的阿氏评分。结果 所有患者的Bromage评分均为6，两组之间麻醉溶液的总消耗量相当。与0.1%组相比，0.2%组的女性疼痛缓解程度更高且满意度更高。关于0.2%组，舒张压和阿氏评分较低，同时产科医生观察到满意的第二产程较低。结论 两种罗哌卡因方案均能为预期母亲提供满意的分娩硬膜外镇痛，且无任何运动阻滞。
