Camann W R, Minzter B H, Denney R A, Datta S
Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Anesthesiology. 1993 May;78(5):870-4; discussion 23A-24A. doi: 10.1097/00000542-199305000-00010.
Intrathecal sufentanil has been found to provide profound analgesia during labor. Epinephrine, when added to various local anesthetic agents or opioids, may modify the analgesic profile and incidence of side effects. The authors sought to determine the effect of adding 0.2 mg epinephrine to 10 micrograms sufentanil when administered for analgesia during labor.
Forty women during active labor received 10 micrograms intrathecal sufentanil either with (n = 20) or without (n = 20) 0.2 mg epinephrine in a randomized, blinded fashion. A combined spinal-epidural technique was used in which a 25-G Whitacre spinal needle was passed through a standard 17-G epidural needle. After injection of the study drug, an epidural catheter was passed, but no local anesthetics were given. Analgesia was quantitated using visual analog scores, as well as time elapsed until first request for additional analgesia via the epidural catheter (0.25% bupivacaine). The incidence and severity of pruritus, nausea, and somnolence were assessed.
The duration (median, range) of analgesia was 90 (40-310) min in the plain sufentanil group (SUF) and 90 (45-230) min in the sufentanil-epinephrine (SUF-EPI) group (P = NS). The onset of analgesia was rapid (within 5 min) in both groups and visual analog scores did not differ at any observation point between groups. The incidence of pruritus was 80% (16/20) in the SUF group, and 45% (9/20) in the SUF-EPI group (P = 0.05). Four patients in the SUF group rated the pruritus as severe versus none in the SUF-EPI groups (P = 0.05). Seven patients (35%) in the SUF-EPI group experienced nausea, versus none in the SUF group (P = 0.004). No patient developed hypotension, motor blockade, fetal heart rate abnormalities, excessive sedation, or postdural puncture headache.
Intrathecal sufentanil 10 micrograms, both with and without epinephrine, provided rapid-onset, albeit short-duration, analgesia during labor. Epinephrine did not prolong the duration of intrathecal sufentanil analgesia. The addition of epinephrine increased the incidence of nausea and decreased the incidence and severity of pruritus.
已发现鞘内注射舒芬太尼可在分娩期间提供深度镇痛。肾上腺素添加到各种局部麻醉剂或阿片类药物中时，可能会改变镇痛效果和副作用发生率。作者试图确定在分娩镇痛时将0.2毫克肾上腺素添加到10微克舒芬太尼中的效果。
40名活跃期分娩的女性以随机、盲法接受10微克鞘内舒芬太尼，其中20名添加（n = 20）0.2毫克肾上腺素，20名不添加（n = 20）。采用联合腰麻-硬膜外技术，使用25G Whitacre腰麻针穿过标准的17G硬膜外针。注射研究药物后，置入硬膜外导管，但不给予局部麻醉剂。使用视觉模拟评分以及直至首次通过硬膜外导管（0.25%布比卡因）要求追加镇痛的时间来定量镇痛效果。评估瘙痒、恶心和嗜睡的发生率及严重程度。
单纯舒芬太尼组（SUF）镇痛持续时间（中位数，范围）为90（40 - 310）分钟，舒芬太尼-肾上腺素组（SUF-EPI）为90（45 - 230）分钟（P = 无显著差异）。两组镇痛起效均迅速（5分钟内），且各观察点两组视觉模拟评分无差异。SUF组瘙痒发生率为80%（16/），SUF-EPI组为45%（9/20）（P = 0.05）。SUF组有4名患者将瘙痒评为重度，而SUF-EPI组无（P = 0.05）。SUF-EPI组有7名患者（35%）出现恶心，SUF组无（P = 0.004）。无患者发生低血压、运动阻滞、胎儿心率异常、过度镇静或硬膜穿刺后头痛。
鞘内注射10微克舒芬太尼，无论是否添加肾上腺素，在分娩期间均能迅速起效，尽管持续时间较短。肾上腺素并未延长鞘内舒芬太尼镇痛的持续时间。添加肾上腺素增加了恶心的发生率，并降低了瘙痒的发生率及严重程度。
