R S Reshma, Karigar Shivanand L, Kori Shreedevi, S D Pratibha
Anaesthesiology, Shri B. M. Patil Medical College Hospital and Research Center, Bijapur Lingayat District Educational (Deemed to be University), Vijayapura, IND.
Obstetrics and Gynaecology, Shri B. M. Patil Medical College Hospital and Research Center, Bijapur Lingayat District Educational (Deemed to be University), Vijayapura, IND.
Cureus. 2024 Aug 29;16(8):e68076. doi: 10.7759/cureus.68076. eCollection 2024 Aug.
Background An epidural block is a superior potent approach to labour analgesia, and ropivacaine combined with fentanyl has been successfully practised for it. Dexmedetomidine, as a novel form of labour analgesia, must be researched further. Our study results give insight into the epidural block and come up with a pioneering approach for labour analgesia. Methodology A total of 68 parturients were assigned to two equal groups and received either dexmedetomidine with ropivacaine (Group RD) or fentanyl with ropivacaine (Group RF). Parturients received a loading dose and maintenance was given using a patient-controlled analgesia (PCA) pump. Analgesia onset time, labour duration, rescue dose requirement, and Visual Analogue Scale (VAS) pain scores were noted. Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores of newborns, Ramsay Sedation Scale (RSS) scores of mothers, and maternal side effects were observed. Results Group RD showed a shorter onset time of analgesia (group RD: 12.50 ± 1.31 minutes vs. group RF: 15.26 ± 1.46 min), less local anaesthetics requirement (group RD: 47.54 ±5.37 ml vs. group RF: 59.05 ± 6.62 ml), less number of bolus doses (group RD: 0.15 ± 0.36 vs. group RF: 1.21 ± 0.95), and shorter duration from the epidural administration to the delivery (group RD: 312.97 ± 42.40 minutes vs. group RF: 345.94 ±14.67 minutes) than group RF. VAS values of the RD group were significantly less than the RF group. The RSS scores were comparably low in both groups, and excessive sedation was not seen in any group. Newborn APGAR values were comparably on the higher side in the two groups. Adverse effects were observed in the two groups, like hypotension, nausea/vomiting, bradycardia, shivering, and pruritus, which were insignificant. Conclusion The RD group showed an improved analgesic effect with a quicker onset of action, reduced requirement of local anaesthetics, and lower VAS scores compared to the RF group. With ropivacaine, dexmedetomidine shows more efficacy than fentanyl during epidural block and is a safe alternative for labour pain management.
硬膜外阻滞是分娩镇痛的一种强效方法，罗哌卡因联合芬太尼已成功应用于此。右美托咪定作为一种新型分娩镇痛方式，仍需进一步研究。我们的研究结果深入了解了硬膜外阻滞，并提出了一种开创性的分娩镇痛方法。
将68例产妇平均分为两组，分别接受右美托咪定联合罗哌卡因（RD组）或芬太尼联合罗哌卡因（RF组）。产妇接受负荷剂量，并使用患者自控镇痛（PCA）泵进行维持。记录镇痛起效时间、产程、补救剂量需求和视觉模拟评分（VAS）疼痛评分。观察新生儿的外观、脉搏、 grimace、活动和呼吸（APGAR）评分、母亲的拉姆齐镇静评分（RSS）以及母亲的副作用。
RD组的镇痛起效时间较短（RD组：12.50±1.31分钟 vs. RF组：15.26±1.46分钟），局部麻醉药需求量较少（RD组：47.54±5.37 ml vs. RF组：59.05±6.62 ml），推注次数较少（RD组：0.15±0.36 vs. RF组：1.21±0.95），从硬膜外给药到分娩的时间较短（RD组：312.97±42.40分钟 vs. RF组：345.94±14.67分钟）。RD组的VAS值显著低于RF组。两组的RSS评分相对较低，且两组均未出现过度镇静。两组新生儿的APGAR值相对较高。两组均观察到不良反应，如低血压、恶心/呕吐、心动过缓、寒战和瘙痒，但均不显著。
与RF组相比，RD组的镇痛效果更佳，起效更快，局部麻醉药需求量减少，VAS评分更低。在硬膜外阻滞期间，右美托咪定与罗哌卡因联合使用时比芬太尼更有效，是分娩疼痛管理的一种安全替代方法。
