Davies M W, Harrison J C, Ryan T D
Department of Anaesthesia, Liverpool Maternity Hospital, Merseyside.
Anaesthesia. 1993 Jan;48(1):63-5.
A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivacaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top-up, whereas 0.25% was most often used during the first stage of labour. Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
我们对英国所有产科单位进行了一项邮政调查，以获取有关分娩硬膜外镇痛政策的信息。平均硬膜外使用率为19.7%，78%的单位提供24小时服务。大多数单位在患者侧卧时采用中线入路插入硬膜外导管，使用空气和生理盐水阻力消失法的情况几乎相同。大多数单位使用3毫升0.5%布比卡因作为试验剂量，只有10%的单位在试验剂量中使用肾上腺素。在后续追加药物时很少使用肾上腺素。0.5%布比卡因最常用于初始和第二产程追加药物，而0.25%最常用于第一产程。75%的单位允许助产士进行追加药物，其中只有14%的情况是从局部麻醉药储液器中抽取。28%的单位常规使用连续输注麻醉药的硬膜外镇痛，主要使用0.125%布比卡因；其中约一半的单位这样做是因为助产士无法进行追加药物。当使用麻醉药输注时，硬膜外阿片类药物的常规使用最为频繁，否则并不常见。
