Grieco W M, Norris M C, Leighton B L, Arkoosh V A, Huffnagle H J, Honet J E, Costello D
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Anesth Analg. 1993 Dec;77(6):1149-54. doi: 10.1213/00000539-199312000-00012.
Intrathecal opioids can provide labor analgesia. We attempted to prolong the duration of intrathecal sufentanil analgesia by adding epinephrine or morphine. Forty-one healthy, term nulliparae with cervical dilation < 5 cm participated in this double-blind, randomized protocol. Using a combined spinal and epidural technique, we gave intrathecal injections of either sufentanil 10 micrograms, sufentanil 10 micrograms plus epinephrine 200 micrograms, or sufentanil 10 micrograms plus morphine 250 micrograms. At baseline and every 5 min for 30 min thereafter, we recorded arterial blood pressure and asked the patients to rate their pain, nausea, and pruritus on visual analog scales. The women continued to rate these variables every 30 min until they requested additional analgesia. They then received 10 mL of 0.25% bupivacaine via the epidural catheter, and rated the above variables every 30 min until they requested additional epidural drug injection. Both morphine and epinephrine prolonged the duration of sufentanil analgesia. Only morphine prolonged analgesia after the first dose of epidural bupivacaine. However, because women in the morphine group experienced significantly more side effects throughout the study period, we do not recommend intrathecal morphine for labor analgesia.
鞘内注射阿片类药物可提供分娩镇痛。我们试图通过添加肾上腺素或吗啡来延长鞘内注射舒芬太尼的镇痛持续时间。41名宫颈扩张<5 cm的健康足月未产妇参与了这项双盲随机试验。采用腰麻-硬膜外联合技术，鞘内注射10微克舒芬太尼、10微克舒芬太尼加200微克肾上腺素或10微克舒芬太尼加250微克吗啡。在基线时以及此后30分钟内每5分钟记录一次动脉血压，并要求患者用视觉模拟评分法对疼痛、恶心和瘙痒进行评分。这些女性每30分钟继续对这些变量进行评分，直到她们要求追加镇痛。然后，她们通过硬膜外导管接受10 mL 0.25%布比卡因，并每30分钟对上述变量进行评分，直到她们要求追加硬膜外药物注射。吗啡和肾上腺素均延长了舒芬太尼的镇痛持续时间。只有吗啡在首次硬膜外注射布比卡因后延长了镇痛时间。然而，由于吗啡组女性在整个研究期间出现了明显更多的副作用，我们不建议鞘内注射吗啡用于分娩镇痛。
