Ferouz F, Norris M C, Arkoosh V A, Leighton B L, Boxer L M, Corba R J
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Anesthesiology. 1997 Mar;86(3):592-8. doi: 10.1097/00000542-199703000-00010.
Intrathecal sufentanil relieves labor pain but centrally mediated side effects are common. Preventing rostral spread of intrathecal sufentanil should limit these side effects. Both direction of the lateral opening of a pencil-point needle and drug baricity modify the spread of intrathecal local anesthetics. This randomized, prospective, double-blind study examines the effects of these variables on intrathecal sufentanil labor analgesia.
Forty laboring, full-term parturients, whose cervixes were dilated less than 5 cm and who requested analgesia for labor were enrolled. Combined spinal epidural analgesia was induced in patients in the sitting position. They were allocated to receive 10 micrograms intrathecal sufentanil diluted with either normal saline or dextrose with the aperture of the pencil-point needle directed cephalad or caudad during drug injection. Thus there were four groups of ten patients: dextrose up, dextrose down, saline up, and saline down. Sufentanil was diluted with normal saline to a concentration of 10 micrograms/ml. The study drug was made by mixing 1 ml sufentanil solution with either 1 ml 10% dextrose or 1 ml normal saline. Visual analog scores for pain, pruritus, nausea, and pain relief were recorded before and 5, 10, 15, and 30 min after drug injection.
Baricity, but not needle orientation, influenced pain relief and pruritus. Sufentanil in dextrose produced less itching but also less analgesia. Nine of 20 women in the dextrose groups compared with 1 of 20 in the saline groups requested additional analgesia by 30 min.
Little or no labor analgesia developed for patients receiving sufentanil with dextrose. A supraspinal action may contribute to intrathecal sufentanil's analgesic efficacy.
鞘内注射舒芬太尼可缓解分娩疼痛，但中枢介导的副作用很常见。防止鞘内注射舒芬太尼向上扩散应能限制这些副作用。笔尖式腰麻针侧孔的方向和药物比重都会改变鞘内局部麻醉药的扩散。这项随机、前瞻性、双盲研究探讨了这些变量对鞘内注射舒芬太尼分娩镇痛的影响。
纳入40名足月分娩的产妇，宫颈扩张小于5cm且要求分娩镇痛。患者在坐位下实施腰麻-硬膜外联合镇痛。在药物注射期间，将她们分为四组，每组10名患者，分别接受用生理盐水或葡萄糖稀释的10微克鞘内舒芬太尼，笔尖式腰麻针的开口分别朝上或朝下。因此，四组分别为：葡萄糖朝上组、葡萄糖朝下组、生理盐水朝上组和生理盐水朝下组。舒芬太尼用生理盐水稀释至浓度为10微克/毫升。研究药物是通过将1毫升舒芬太尼溶液与1毫升10%葡萄糖或1毫升生理盐水混合制成。在注射药物前以及注射后5、10、15和30分钟记录疼痛、瘙痒、恶心的视觉模拟评分以及疼痛缓解情况。
比重而非针的方向影响疼痛缓解和瘙痒。葡萄糖溶液中的舒芬太尼引起的瘙痒较少，但镇痛效果也较差。葡萄糖组20名女性中有9名在30分钟时要求追加镇痛，而生理盐水组20名女性中只有1名。
接受葡萄糖溶液中舒芬太尼的患者几乎没有或没有产生分娩镇痛效果。脊髓上的作用可能有助于鞘内舒芬太尼的镇痛效果。
