Sharma S K, Sidawi J E, Ramin S M, Lucas M J, Leveno K J, Cunningham F G
University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Anesthesiology. 1997 Sep;87(3):487-94. doi: 10.1097/00000542-199709000-00006.
Reports indicate that the administration of epidural analgesia for pain relief during labor interferes with labor and increases cesarean deliveries. However, only a few controlled trials have assessed the effect of epidural analgesia on the incidence of cesarean delivery. The authors' primary purpose in this randomized study was to evaluate the effects of epidural analgesia on the rate of cesarean deliveries by providing a suitable alternative: patient-controlled intravenous analgesia.
Seven hundred fifteen women of mixed parity in spontaneous labor at full term were randomly assigned to receive either epidural analgesia or patient-controlled intravenous meperidine analgesia. Epidural analgesia was maintained with a continuous epidural infusion of 0.125% bupivacaine with 2 microg/ml fentanyl. Patient-controlled analgesia was maintained with 10-15 mg meperidine given every 10 min as needed using a patient-controlled pump. Procedures recorded in a manual that prescribed the intrapartum management were followed for each woman randomized in the study.
A total of 358 women were randomized to receive epidural analgesia, and 243 (68%) of these women complied with the epidural analgesia protocol. Similarly, 357 women were randomized to receive patient-controlled intravenous meperidine analgesia, and 259 (73%) of these women complied with the patient-controlled intravenous analgesia protocol. Only five women who were randomized and received patient-controlled intravenous meperidine analgesia according to the protocol crossed over to epidural analgesia due to inadequate pain relief. There was no difference in the rate of cesarean deliveries between the two analgesia groups using intention-to-treat analysis based on the original randomization (epidural analgesia, 4% [95% CI: 1.9-6.2%] compared with patient-controlled intravenous analgesia, 5% [95% CI: 2.6-7.2%]). Similar results were observed for the analysis of the protocol-compliant groups (epidural analgesia, 5% [95% CI: 2.6-8.5%] compared with patient-controlled intravenous analgesia, 6% [95% CI: 3-8.9%]). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received patient-controlled intravenous analgesia.
Epidural analgesia was not associated with increased numbers of cesarean delivery when compared with a suitable alternative method of analgesia.
报告显示，分娩期间使用硬膜外镇痛缓解疼痛会干扰产程并增加剖宫产率。然而，仅有少数对照试验评估了硬膜外镇痛对剖宫产发生率的影响。在这项随机研究中，作者的主要目的是通过提供一种合适的替代方法——患者自控静脉镇痛，来评估硬膜外镇痛对剖宫产率的影响。
715名足月自然分娩的经产妇被随机分配接受硬膜外镇痛或患者自控静脉注射哌替啶镇痛。硬膜外镇痛通过持续硬膜外输注含2微克/毫升芬太尼的0.125%布比卡因来维持。患者自控镇痛通过患者自控泵按需每10分钟给予10 - 15毫克哌替啶来维持。对研究中随机分组的每位女性，遵循一本规定产时管理的手册中记录的程序。
共有358名女性被随机分配接受硬膜外镇痛，其中243名（68%）女性遵循硬膜外镇痛方案。同样，357名女性被随机分配接受患者自控静脉注射哌替啶镇痛，其中259名（73%）女性遵循患者自控静脉镇痛方案。只有5名根据方案被随机分配并接受患者自控静脉注射哌替啶镇痛的女性因镇痛效果不佳而改用硬膜外镇痛。基于最初随机分组进行意向性分析时，两组镇痛方法的剖宫产率无差异（硬膜外镇痛组为4% [95%可信区间：1.9 - 6.2%]，患者自控静脉镇痛组为5% [95%可信区间：2.6 - 7.2%]）。对遵循方案组的分析也观察到类似结果（硬膜外镇痛组为5% [95%可信区间：2.6 - 8.5%]，患者自控静脉镇痛组为6% [95%可信区间：3 - 8.9%]）。与接受患者自控静脉镇痛的女性相比，接受硬膜外镇痛的女性在分娩期间报告的疼痛评分更低。
与一种合适的替代镇痛方法相比，硬膜外镇痛与剖宫产数量增加无关。
