Ferrante F M, Rosinia F A, Gordon C, Datta S
Division of Obstetric Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Anesth Analg. 1994 Jul;79(1):80-4. doi: 10.1213/00000539-199407000-00015.
The use of a background infusion with intravenous patient-controlled analgesia (IV-PCA) increases drug consumption without any additional contribution to analgesia. There are no data on the potential advantage of a background infusion administered with patient-controlled epidural analgesia (PCEA) for labor and delivery. Sixty women were randomized to one of four groups and received either: (a) demand dose PCEA (demand dose = 3 mL; lockout interval = 10 min); (b) continuous infusion plus demand dose PCEA (two separate infusion rates: 3 mL/h and 6 mL/h); or (c) a fixed-rate continuous epidural infusion (CEI) at 12 mL/h. All patients received 0.125% bupivacaine with 2 micrograms/mL of fentanyl. The study protocol was double-blind and placebo-controlled. Visual analog pain scores, motor strength, and bilateral pinprick analgesia were assessed every half hour by a blinded observer. Pain scores, cephalad extent of sensory analgesia, and motor block were no different among the study groups during the first and second stages of labor. Cumulative hourly bupivacaine use was similar among all PCEA study groups. However, use of PCEA (in whatever mode) provided a 35% dose-sparing effect in comparison to CEI. The PCEA groups receiving no background infusion or a 3-mL/h background infusion had a greater need for physician-administered supplemental bupivacaine during the first stage of labor. While not statistically significant, a trend toward increased need for supplementation was seen in these same patient groups over the entire course of labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
静脉自控镇痛（IV - PCA）中使用背景输注会增加药物消耗，且对镇痛无额外作用。关于分娩时背景输注联合自控硬膜外镇痛（PCEA）的潜在优势尚无数据。60名女性被随机分为四组，分别接受：（a）按需剂量PCEA（按需剂量 = 3 mL；锁定时间间隔 = 10分钟）；（b）持续输注加按需剂量PCEA（两种不同输注速率：3 mL/h和6 mL/h）；或（c）12 mL/h的固定速率持续硬膜外输注（CEI）。所有患者均接受含2微克/毫升芬太尼的0.125%布比卡因。研究方案为双盲且安慰剂对照。由一名盲法观察者每半小时评估视觉模拟疼痛评分、肌力和双侧针刺镇痛情况。在分娩的第一和第二阶段，各研究组之间的疼痛评分、感觉镇痛的头端范围和运动阻滞无差异。所有PCEA研究组每小时布比卡因的累积用量相似。然而，与CEI相比，使用PCEA（无论何种模式）可节省35%的剂量。在分娩第一阶段，未接受背景输注或接受3 mL/h背景输注的PCEA组对医生给予补充布比卡因的需求更大。在整个分娩过程中，这些相同患者组虽无统计学意义，但补充需求增加的趋势明显。（摘要截选至250字）
