Vilanova F, Santacana E, García V, Villar-Landeira J M
Servico de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona.
Rev Esp Anestesiol Reanim. 1994 Jul-Aug;41(4):205-8.
To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth.
Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out.
Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable.
Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.
确定布比卡因、肾上腺素和芬太尼持续硬膜外灌注在阴道分娩第一和第二产程中缓解疼痛的疗效及并发症。
1990年1月至1993年3月期间，我们对1307名妇女在分娩时采用持续硬膜外灌注来控制疼痛。通过硬膜外导管给药，先给予10毫升含0.25%布比卡因、1:200,000肾上腺素和25微克芬太尼的推注剂量，之后以12毫升/小时的输注速率持续灌注含1:200,000肾上腺素和2微克/毫升芬太尼的0.0625%布比卡因。当镇痛效果不佳时，给予一剂局部麻醉药或实施阴部神经阻滞。
92%的分娩妇女在第一产程报告镇痛效果良好；7%效果尚可，0.55%效果不佳。在第二产程中，88%报告镇痛效果满意，8%效果尚可或不佳。其余接受剖宫产的妇女无法进行评估。并发症较少且易于控制。
用含1:200,000肾上腺素和2微克/毫升芬太尼的0.0625%布比卡因进行硬膜外持续灌注可在分娩各阶段提供足够的镇痛效果。
