Cohen S, Amar D, Pantuck C B, Pantuck E J, Goodman E J, Leung D H
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA.
Can J Anaesth. 1996 Apr;43(4):341-6. doi: 10.1007/BF03011711.
The highly lipid soluble opioids, fentanyl and sufentanil, are used in combination with local anaesthetics with/without epinephrine to provide epidural analgesia during labour and delivery. Our aim was to determine whether wither opioid was superior when used with low dose local anaesthetic.
In a double-blind study patients were randomized to two epidural infusion groups: Group I (n = 50) fentanyl 2 micrograms.ml-1 with bupivacaine 0.015% and epinephrine 2 micrograms.ml-1, Group II(n = 50) sufentanil 1 microgram.ml-1 with bupivacaine 0.015% and epinephrine 2 micrograms.ml-1. Following a 20 ml bolus of the study solution an infusion was started at 10 ml.h-1. To achieve analgesia patients could receive two boluses of 5 ml of the study solution and if analgesia was still inadequate, a further 5 ml bupivacaine 0.25% was used. Pain and overall satisfaction were assessed with a 10-point visual scale. Plasma samples obtained from the mother at the time the infusion was discontinued and from the umbilical cord vein at delivery were assayed to determine opioid concentration.
Pain scores were greater for Group I than for Group II patients throughout the first and second stages of labour (P = 0.002). More patients in Group I (42%) requested a dose of bupivacaine 0.25% than in Group II (6%) (P < 0.001) and the total dose of bupivacaine given to Group I patients was greater than that of Group II, 26.0 +/- 22.0 mg vs. 13.4 +/- 12.6 mg, P = 0.005. There were no differences with respect to first or second stage duration, incidence of side effects, infusion duration, outcome of labour or neonatal Apgar scores. There was no opioid accumulation in either maternal or foetal blood.
Epidural opioid infusion with very low dose bupivacaine (0.015%) achieved an overall high level of patient satisfaction in both groups without serious maternal or neonatal side effects. At the fentanyl-to-sufentanil ratio used here patients receiving sufentanil had lower pain scores and substantially fewer patients required bupivacaine rescue.
高度脂溶性阿片类药物芬太尼和舒芬太尼，与含或不含肾上腺素的局部麻醉药联合使用，以在分娩期间提供硬膜外镇痛。我们的目的是确定在与低剂量局部麻醉药联用时，这两种阿片类药物哪种更具优势。
在一项双盲研究中，患者被随机分为两个硬膜外输注组：第一组（n = 50），芬太尼2微克/毫升，布比卡因0.015%，肾上腺素2微克/毫升；第二组（n = 50），舒芬太尼1微克/毫升，布比卡因0.015%，肾上腺素2微克/毫升。在推注20毫升研究溶液后，以10毫升/小时的速度开始输注。为达到镇痛效果，患者可接受两次5毫升的研究溶液推注，如果镇痛效果仍不理想，则使用5毫升0.25%的布比卡因。用10分视觉量表评估疼痛和总体满意度。在输注停止时从母亲处以及在分娩时从脐静脉采集血浆样本，测定阿片类药物浓度。
在第一产程和第二产程中，第一组患者的疼痛评分均高于第二组患者（P = 0.002）。第一组中更多患者（42%）需要一剂0.25%的布比卡因，而第二组为6%（P < 0.001），且给予第一组患者的布比卡因总剂量大于第二组，分别为26.0±22.0毫克和13.4±12.6毫克，P = 0.005。在第一产程或第二产程持续时间、副作用发生率、输注持续时间、分娩结局或新生儿阿氏评分方面无差异。母体或胎儿血液中均无阿片类药物蓄积。
硬膜外输注极低剂量布比卡因（0.015%）在两组中均实现了总体较高的患者满意度，且无严重的母体或新生儿副作用。在此处使用的芬太尼与舒芬太尼比例下，接受舒芬太尼的患者疼痛评分更低，需要布比卡因补救的患者大幅减少。
