Ranta P, Jouppila P, Spalding M, Kangas-Saarela T, Jouppila R
Department of Anesthesiology, Oulu University Central Hospital, Finland.
Acta Obstet Gynecol Scand. 1995 Feb;74(2):122-6. doi: 10.3109/00016349509008919.
Two hundred and forty-eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injection technique were studied prospectively during the progress of labor in the three month study period. Parturients with signs of fetal distress were excluded. Pain level and the maternal, fetal and neonatal effects related to PCB were evaluated.
Pain intensity level was assessed on a visual scoring scale (0-10). The intrapartum fetal heart rate patterns were recorded and reviewed to correlate the incidence of paracervical fetal bradycardia.
Parturients with PCB were provided a significant reduction (p < 0.001) in pain levels and the change in pain scores could be maintained until the beginning of the second stage. After the block, bradycardia patterns were noted in five (2.0%) fetuses, a fetal heart rate ranged from 60 to 105 beats per minute with an onset time of 2-20 minutes after the block and a duration of 4-12 minutes. All newborns in the bradycardia group were delivered vaginally without signs of asphyxia.
PCB in selected parturients with a low-dose superficial technique has been shown to be an effective analgesic modality with minimal fetal and neonatal side-effects, but post-blockade fetal bradycardia cannot be wholly eliminated.
在为期三个月的研究期间，前瞻性地研究了248例连续分娩产妇，采用浅表注射技术给予0.25%布比卡因宫颈旁阻滞（PCB）。排除有胎儿窘迫迹象的产妇。评估疼痛程度以及与PCB相关的母体、胎儿和新生儿影响。
采用视觉评分量表（0 - 10）评估疼痛强度水平。记录并回顾产时胎儿心率模式，以关联宫颈旁胎儿心动过缓的发生率。
接受PCB的产妇疼痛水平显著降低（p < 0.001），且疼痛评分的变化可维持至第二产程开始。阻滞术后，五例（2.0%）胎儿出现心动过缓模式，胎儿心率在每分钟60至105次之间，发作时间在阻滞后2至20分钟，持续时间为4至12分钟。心动过缓组的所有新生儿均经阴道分娩，无窒息迹象。
对于选定的产妇，低剂量浅表技术的PCB已被证明是一种有效的镇痛方式，对胎儿和新生儿的副作用最小，但阻滞术后胎儿心动过缓无法完全消除。
