Gautier P E, Debry F, Fanard L, Van Steenberge A, Hody J L
Department of Anesthesiology, Clinique Ste. Anne-St. Remi, Brussels, Belgium.
Reg Anesth. 1997 Mar-Apr;22(2):143-9. doi: 10.1016/s1098-7339(06)80033-7.
Subarachnoid sufentanil 5 micrograms during labor is known to have variable results. However, subarachnoid sufentanil 5 micrograms plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 micrograms to this mixture.
Forty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 micrograms and bupivacaine 1 mg with or without epinephrine 25 micrograms. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.
Addition of epinephrine prolonged the duration of analgesia from 103.8 +/- 28.2 minutes to 142 +/- 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.
This minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 +/- 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.
分娩时蛛网膜下腔注射5微克舒芬太尼的效果不一。然而，蛛网膜下腔注射5微克舒芬太尼加1毫克布比卡因可提供平均持续时间为100分钟的良好分娩镇痛效果。本研究的目的是探讨在此混合物中添加25微克肾上腺素的效果。
42例宫颈扩张小于5厘米的产妇参与了这项双盲、随机研究。采用联合腰麻-硬膜外技术进行蛛网膜下腔给药，给予5微克舒芬太尼和1毫克布比卡因，其中一组添加25微克肾上腺素，另一组不添加。通过视觉模拟评分评估镇痛效果。记录首次要求追加镇痛的时间、血压、心率、感觉平面、运动阻滞以及瘙痒、恶心和镇静的发生率。
添加肾上腺素后，镇痛持续时间从103.8±28.2分钟延长至142±54.3分钟，感觉阻滞的中位头侧平面从T3降至T6。两组的副作用发生率和运动表现相似；每组均有19例患者能够行走。
这种最低剂量的布比卡因-舒芬太尼-肾上腺素混合物可提供持续时间为142±54.3分钟的高质量镇痛，感觉阻滞平面低且无运动阻滞。然而，低血压可能作为晚期副作用出现。
