Breen T W, Shapiro T, Glass B, Foster-Payne D, Oriol N E
Department of Anesthesia, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 1993 Nov;77(5):919-24. doi: 10.1213/00000539-199311000-00008.
The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.
通过前瞻性、随机、双盲设计，比较了两种硬膜外镇痛方案对分娩期女性行走能力的影响。一组患者接受硬膜外注射芬太尼，负荷剂量75微克，然后以2.5微克/毫升的速度输注，输注速度为15毫升/小时（芬太尼组，n = 53）。第二组接受超低剂量布比卡因（0.04%）、肾上腺素（1.7微克/毫升）和芬太尼（1.7微克/毫升）（布比卡因-肾上腺素-芬太尼组，n = 77），负荷剂量15毫升，然后以15毫升/小时的速度输注。芬太尼组90.6%的患者和布比卡因-肾上腺素-芬太尼组92.2%的患者迅速获得了充分镇痛（P = 0.89）。芬太尼组70%的患者能够行走，另一组为68%。布比卡因-肾上腺素-芬太尼混合液提供的镇痛持续时间更长（分别为287±171分钟和156±72分钟，P = 0.0001）。仅在使用研究药物（无需更高剂量局部麻醉药）期间分娩的患者比例，布比卡因-肾上腺素-芬太尼组为52%，芬太尼组为21%（P = 0.0005）。布比卡因-肾上腺素-芬太尼组17%的患者出现妨碍行走的髋部屈曲无力（P = 0.002），9%的患者出现体位性低血压（P = 0.08）。芬太尼组未出现上述问题。两组的新生儿结局相似。接受芬太尼或超低剂量布比卡因、肾上腺素和芬太尼硬膜外镇痛的女性中，约70%在分娩期间可安全行走。
