地佐辛联合罗哌卡因用于分娩期硬膜外镇痛的效果：一项随机对照试验
Effects of dezocine with ropivacaine on epidural analgesia during labor: a randomized controlled trial.
作者信息
Su Bin, Qian Panlian, Zhang W P, Hou Yi, Shen Yiyi
机构信息
Department of Anesthesiology, Tongxiang Maternity and Child Health Hospital, Jiaxing, China.
Department of Obstetrics and gynecology, Tongxiang Maternity and Child Health Hospital, Jiaxing, China.
出版信息
Front Pharmacol. 2025 Apr 28;16:1586393. doi: 10.3389/fphar.2025.1586393. eCollection 2025.
BACKGROUND
Adding μ-opioid receptor agonists to local anesthetics are usually used for labor analgesia, while they are associated with pruritus. Kappa opioid agonists (dezocine) are widely used for pain management. Recently, they have emerged as a novel type of potent antipruritic agents. The purpose of this study was to investigate the effects of dezocine with ropivacaine on epidural analgesia during labor.
METHODS
A total of 120 parturients were randomly divided into two groups (60 cases each). The group D received 0.1% ropivacaine with dezocine 0.2 mg/mL for epidural analgesia while the control group received 0.1% ropivacaine with sufentanil 0.4 μg/mL for epidural analgesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were monitored. The onset time and duration of analgesia, pain intensity, Bromage scores, delivery outcome, neonatal Apgar scores, and adverse events of mothers and neonates were recorded. Pain intensity was assessed using visual analogue scale (VAS). Umbilical arterial blood was collected for analysis.
RESULTS
The incidence of itching was lower in the group D than the control group (0% vs. 10%, = 0.036). The duration of analgesia was longer in the group D (76.1 ± 9.7 vs. 72.1 ± 10.5 min, = 0.032), and numbers of boluses were fewer in the group D (median, 2 vs.3, = 0.018). The onset time of analgesia and VAS values were similar between the two groups (all > 0.05). There were no significant differences in terms of hypotension, bradycardia, motor block, respiratory depression, fetal acidosis, nausea and vomiting between the two groups.
CONCLUSION
This study indicated that the epidural use of dezocine increased the analgesic effect, prolonged the duration of analgesia and decreased the incidence of itching during labor without increasing adverse events of mothers and neonates.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn, identifier ChiCTR2000035341.
背景
将μ-阿片受体激动剂添加到局部麻醉剂中通常用于分娩镇痛，但其与瘙痒有关。κ-阿片受体激动剂（地佐辛）广泛用于疼痛管理。最近，它们已成为一种新型的强效止痒剂。本研究的目的是探讨地佐辛与罗哌卡因联合用于分娩期间硬膜外镇痛的效果。
方法
总共120名产妇被随机分为两组（每组60例）。D组接受0.1%罗哌卡因加0.2mg/mL地佐辛用于硬膜外镇痛，而对照组接受0.1%罗哌卡因加0.4μg/mL舒芬太尼用于硬膜外镇痛。监测收缩压（SBP）、舒张压（DBP）和心率（HR）。记录镇痛的起效时间和持续时间、疼痛强度、布罗玛分级、分娩结局、新生儿阿普加评分以及母亲和新生儿的不良事件。使用视觉模拟量表（VAS）评估疼痛强度。采集脐动脉血进行分析。
结果
D组瘙痒发生率低于对照组（0%对10%，P = 0.036）。D组镇痛持续时间更长（76.1±9.7对72.1±10.5分钟，P = 0.032），且D组追加剂量次数更少（中位数，2次对3次，P = 0.018）。两组之间镇痛起效时间和VAS值相似（均P>0.05）。两组在低血压、心动过缓、运动阻滞、呼吸抑制、胎儿酸中毒、恶心和呕吐方面无显著差异。
结论
本研究表明，硬膜外使用地佐辛可增强分娩期间的镇痛效果，延长镇痛持续时间并降低瘙痒发生率，且不增加母亲和新生儿的不良事件。
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