Yu Yibing, Zhao Qingsong, Zang Yu, Liu Zhiqiang, Du Weijia
Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Drug Des Devel Ther. 2025 Sep 2;19:7581-7590. doi: 10.2147/DDDT.S545076. eCollection 2025.
To compare analgesic outcomes between single- and multi-orifice epidural catheters at a 360-mL/h delivery rate during programmed intermittent epidural bolus.
In this prospective randomized double-blinded controlled trial, 102 healthy nulliparous parturients requesting labor analgesia at the Shanghai First Maternity and Infant Hospital were enrolled from July to September 2023. Participants were given either single- or multi-orifice catheters for epidural analgesia (0.1% ropivacaine with 0.3 µg/mL of sufentanil; 10 mL every 45 min at 360 mL/h). The primary outcome was ropivacaine consumption per hour, calculated as the total amount of ropivacaine administered divided by the duration of labor analgesia (mg/h).
Median ropivacaine consumption per hour was not significantly different: 12.6 mg/h [11.6-13.2 mg/h] for single-orifice vs 12.8 mg/h [12.3-13.3 mg/h] for multi-orifice catheters (difference 29%; 95% confidence interval [CI], -10.2 to 68.2%; =0.241). No significant differences were found in patient-controlled epidural analgesia boluses requested and delivered, time to first bolus request, or the number of clinician-administered boluses. However, adequate analgesia at 20 min was higher with single-orifice catheters (84.0% vs 63.5%, difference 22.5%; 95% CI: 9.2% to 35.1%, =0.019). Median times to adequate analgesia were 8 min [4-16] vs 15 min [9.5-22.5] for single- and multi-orifice catheters (=0.002). Pain scores differed only at 6 and 18 min. There were no differences in the incidence of motor or unilateral block, side effects, maternal satisfaction, or catheter-related complications between the two groups.
Single-orifice catheters did not enhance analgesia quality during labor maintenance under a 360-mL/h programmed intermittent epidural bolus delivery rate but were linked to more rapid analgesic onset than multi-orifice catheters.
比较在程序化间歇性硬膜外推注期间，以360毫升/小时的输注速率使用单孔和多孔硬膜外导管时的镇痛效果。
在这项前瞻性随机双盲对照试验中，2023年7月至9月期间，上海第一妇婴保健院102名要求分娩镇痛的健康初产妇纳入研究。参与者接受单孔或多孔导管进行硬膜外镇痛（0.1%罗哌卡因加0.3微克/毫升舒芬太尼；360毫升/小时时每45分钟10毫升）。主要结局是每小时罗哌卡因消耗量，计算方法为罗哌卡因给药总量除以分娩镇痛持续时间（毫克/小时）。
每小时罗哌卡因消耗量中位数无显著差异：单孔导管为12.6毫克/小时[11.6 - 13.2毫克/小时]，多孔导管为12.8毫克/小时[12.3 - 13.3毫克/小时]（差异29%；95%置信区间[CI]，-10.2至68.2%；P = 0.241）。在患者自控硬膜外镇痛推注的需求和给予量、首次推注需求时间或临床医生给予的推注次数方面未发现显著差异。然而，单孔导管在20分钟时的充分镇痛率更高（84.0%对63.5%，差异22.5%；95% CI：9.2%至35.1%；P = 0.019）。单孔和多孔导管达到充分镇痛的中位时间分别为8分钟[4 - 16]和15分钟[9.5 - 22.5]（P = 0.002）。疼痛评分仅在6分钟和18分钟时有差异。两组之间运动或单侧阻滞发生率、副作用、产妇满意度或导管相关并发症无差异。
在360毫升/小时的程序化间歇性硬膜外推注输注速率下，单孔导管在分娩维持期间并未提高镇痛质量，但与比多孔导管更快的镇痛起效相关。
