Riley E T, Ratner E F, Cohen S E
Department of Anesthesia, Stanford University School of Medicine, CA 94305, USA.
Anesth Analg. 1997 Feb;84(2):346-51. doi: 10.1097/00000539-199702000-00019.
Sensory changes and hypotension occur after intrathecal sufentanil (ITS) is given during labor. The goal of this study was to determine whether sensory changes are predictive of hemodynamic changes or duration of pain relief. We also examined whether sensory and hemodynamic changes relate to the concentration of ITS administered. Forty-five ASA physical status I and II women in active labor were randomly assigned to receive 10 micrograms ITS diluted in either 1, 2, or 3 mL of normal saline (15 in each group). An observer blinded to treatment recorded verbal pain scores, blood pressure, and sensory changes to light touch, pinprick, and cold at frequent intervals. Excellent analgesia was obtained in 42 of 45 patients. There were no differences among the groups with respect to the number of patients with sensory changes, the duration of analgesia or sensory changes, the quality of analgesia, or the severity of hypotension. The groups were therefore combined for further analyses. Among this combined group, the duration of analgesia was 99 +/- 7 min (mean +/- SE). Cold, pinprick, and light touch sensation were decreased in 66%, 50%, and 33% of patients, respectively. Motor block was absent in all patients. The duration and quality of analgesia were similar in subjects with and without sensory changes. Systolic blood pressure decreased 23 +/- 2 mm Hg (P < 0.05) during the first 30 min after ITS, and six patients were given ephedrine. The magnitude of blood pressure change was not affected by the diluent volume or the presence of sensory changes. Because sensory changes were not predictive of the duration or quality of analgesia or the degree of hemodynamic change, we conclude that analgesia with ITS is predominantly mediated via spinal cord opioid receptors rather than by a local anesthetic-type conduction blockade.
分娩期间给予鞘内舒芬太尼（ITS）后会出现感觉变化和低血压。本研究的目的是确定感觉变化是否可预测血流动力学变化或疼痛缓解持续时间。我们还研究了感觉和血流动力学变化是否与所给予的ITS浓度有关。45例处于活跃期分娩的ASA身体状况I级和II级女性被随机分配接受稀释于1、2或3 mL生理盐水中的10微克ITS（每组15例）。一名对治疗不知情的观察者频繁记录言语疼痛评分、血压以及对轻触、针刺和冷刺激的感觉变化。45例患者中有42例获得了良好的镇痛效果。在感觉变化的患者数量、镇痛或感觉变化的持续时间、镇痛质量或低血压严重程度方面，各组之间没有差异。因此将各组合并进行进一步分析。在这个合并组中，镇痛持续时间为99±7分钟（平均值±标准误）。分别有66%、50%和33%的患者冷觉、针刺觉和轻触觉减退。所有患者均无运动阻滞。有感觉变化和无感觉变化的受试者的镇痛持续时间和质量相似。ITS给药后的前30分钟内，收缩压下降23±2 mmHg（P<0.05），6例患者接受了麻黄碱治疗。血压变化幅度不受稀释液体积或感觉变化的影响。由于感觉变化不能预测镇痛的持续时间或质量或血流动力学变化程度，我们得出结论，ITS镇痛主要通过脊髓阿片受体介导，而非通过局部麻醉药类型的传导阻滞。
