Stacey R G, Watt S, Kadim M Y, Morgan B M
RPMS Institute of Obstetrics and Gynaecology, Queen Charlottes Hospital, London.
Br J Anaesth. 1993 Oct;71(4):499-502. doi: 10.1093/bja/71.4.499.
We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. The median height of block was T8 (range T4-L2) and mean duration of analgesia 72 (SD 21) min. Hypotension occurred in two of 30 mothers, but responded to fluids and ephedrine. There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.
对于要求分娩镇痛的产妇，我们采用了单间隙腰麻-硬膜外联合技术。鞘内注射5mg布比卡因原液，镇痛起效的中位时间为3分钟。16%的接受者在10分钟后腹部镇痛效果不佳，尽管所有产妇的会阴镇痛效果良好。阻滞平面的中位高度为T8（范围为T4-L2），镇痛的平均持续时间为72（标准差21）分钟。30名产妇中有2名出现低血压，但经补液和麻黄碱治疗后症状缓解。未发生脊麻后头痛。该技术适用于那些在活跃期要求镇痛的产妇，她们可能没有时间在分娩前实施硬膜外镇痛。如果蛛网膜下腔阻滞效果不佳，或者产程超过蛛网膜下腔阻滞的持续时间，可使用硬膜外导管来改善镇痛效果。
