Beilin Y, Zahn J, Bernstein H H, Zucker-Pinchoff B, Zenzen W J, Andres L A
Department of Anesthesiology and Obstetrics, Mount Sinai School of Medicine, New York, New York, USA.
Anesthesiology. 1998 Jun;88(6):1502-6. doi: 10.1097/00000542-199806000-00013.
Approximately 15% of women still have pain after placement of an epidural catheter and administration of local anesthetic for labor analgesia. Two techniques frequently used to treat this pain were compared: (1) withdrawal of the catheter 1 cm and repeated dosing with additional local anesthetic, and (2) repeated dosing with additional local anesthetic without any catheter manipulation.
Fifteen minutes after placement of a multiple-orifice epidural catheter 5 cm into the epidural space and administration of 13 ml 0.25% bupivacaine to the parturient in labor, the adequacy of analgesia was assessed. All women who had incomplete analgesia were randomized (first intervention) to receive an additional 5 ml 0.25% bupivacaine (local-anestheticonly group) or to receive 5 ml 0.25% bupivacaine after first withdrawing the epidural catheter 1 cm (catheter-manipulation group). If after 15 min the woman still had pain, then (second intervention) the catheter was withdrawn 1 cm and an additional 5 ml 0.25% bupivacaine was administered to the local-anesthetic-only group, whereas 5 ml 0.25% bupivacaine was given to the catheter-manipulation group without further catheter manipulation. The success rate of the second intervention was assessed 15 min later.
Seventy-eight women were enrolled in the study, 39 to each group. In the local-anesthetic-only group, 29 (74%) women were successfully treated with the first intervention and the remaining 10 (100%) were successfully treated with the second intervention. In the catheter-manipulation group, 30 (77%) were successfully treated with the first intervention and 7 (100%; 2 patients were not studied because of investigator error) were successfully treated with the second intervention (P=NS).
Administration of additional local anesthetic without first withdrawing the epidural catheter will effectively treat most women for whom analgesia is incomplete after the placement of an epidural catheter during labor.
在放置硬膜外导管并给予局部麻醉药用于分娩镇痛后，仍有大约15%的女性会感到疼痛。对常用于治疗这种疼痛的两种技术进行了比较：（1）将导管拔出1厘米，并用额外的局部麻醉药重复给药；（2）用额外的局部麻醉药重复给药，而不进行任何导管操作。
在将多孔硬膜外导管置入硬膜外腔5厘米并向分娩中的产妇给予13毫升0.25%布比卡因15分钟后，评估镇痛效果。所有镇痛不完全的女性被随机分组（首次干预），一组接受额外的5毫升0.25%布比卡因（仅局部麻醉药组），另一组在将硬膜外导管先拔出1厘米后接受5毫升0.25%布比卡因（导管操作组）。如果15分钟后该女性仍有疼痛，那么（第二次干预）仅局部麻醉药组将导管拔出1厘米并给予额外的5毫升0.25%布比卡因，而导管操作组则不进一步操作导管，直接给予5毫升0.25%布比卡因。15分钟后评估第二次干预的成功率。
78名女性参与了该研究，每组39名。在仅局部麻醉药组中，29名（74%）女性通过首次干预成功治疗，其余10名（100%）通过第二次干预成功治疗。在导管操作组中，30名（77%）通过首次干预成功治疗，7名（100%；2名患者因研究者失误未纳入研究）通过第二次干预成功治疗（P=无显著差异）。
在分娩期间放置硬膜外导管后镇痛不完全的大多数女性，不先拔出硬膜外导管而给予额外的局部麻醉药可有效治疗。
