Dunn S M, Connelly N R, Steinberg R B, Lewis T J, Bazzell C M, Klatt J L, Parker R K
Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
Anesth Analg. 1998 Aug;87(2):331-5. doi: 10.1097/00000539-199808000-00018.
Intrathecal sufentanil provides approximately 2 h of excellent labor analgesia with minimal motor blockade. Epidural sufentanil has received less scrutiny but may provide the same benefits as intrathecal sufentanil. In this study, we compared epidural sufentanil 40 microg after a lidocaine with an epinephrine test dose with intrathecal (i.t.) sufentanil 10 microg with respect to onset and duration of analgesia, degree of motor block, side effect profile, and mode of delivery. Seventy ASA physical status I or II parturients in early labor (< or = 4 cm cervical dilation) were randomized to receive either i.t. sufentanil 10 microg with a combined spinal-epidural technique (CSE) or epidural sufentanil 40 microg (e.p.) after epidural catheter placement and testing with 3 mL of 1.5% lidocaine with epinephrine (15 microg). After the administration of analgesia, pain scores and side effects were recorded for each patient at 5, 10, 15, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. The study period was completed when the patients requested additional analgesia. All patients, except one, achieved adequate analgesia with the initial study dose and satisfactorily completed the study. There were no demographic differences between the two groups. Pain relief was rapid for all patients; pain scores were significantly lower at 5 and 10 min in the i.t. group versus the e.p. group. The mean duration of analgesia was similar between the e.p. group (127 +/- 40 min) and the i.t. group (110 +/- 48 min). No patient experienced any motor block. Side effects were similar between the two groups, except for pruritus-both the incidence and severity were significantly more profound at 5, 10, 15, 20, and 30 min in the i.t. group. There was no difference in time from analgesic to delivery, incidence of operative or assisted delivery, or cervical dilation at the time of redose. For early laboring patients, epidural sufentanil 40 microg after a lidocaine test dose provides analgesia comparable to that of i.t. sufentanil 10 microg with less pruritus.
We compared the efficacy and side effects of intrathecal sufentanil with epidural sufentanil with a local anesthetic test dose for analgesia during labor. Analgesia was equally good, although the intrathecal group experienced more itching.
鞘内注射舒芬太尼可提供约2小时的良好分娩镇痛，且运动阻滞最小。硬膜外注射舒芬太尼受到的研究较少，但可能与鞘内注射舒芬太尼有相同的益处。在本研究中，我们比较了在利多卡因加肾上腺素试验剂量后硬膜外注射40微克舒芬太尼与鞘内注射10微克舒芬太尼在镇痛起效时间和持续时间、运动阻滞程度、副作用情况及给药方式方面的差异。70例美国麻醉医师协会（ASA）身体状况为I或II级的初产妇（宫颈扩张≤4厘米）被随机分为两组，一组采用腰麻 - 硬膜外联合技术（CSE）鞘内注射10微克舒芬太尼，另一组在硬膜外导管置入并用3毫升1.5%利多卡因加肾上腺素（15微克）测试后硬膜外注射40微克舒芬太尼。给予镇痛药物后，由对所用技术不知情的观察者在5、10、15、20和30分钟以及此后每30分钟记录每位患者的疼痛评分和副作用。当患者要求追加镇痛药物时，研究期结束。除1例患者外，所有患者初始研究剂量均达到充分镇痛并圆满完成研究。两组患者在人口统计学方面无差异。所有患者疼痛缓解迅速；鞘内注射组在5分钟和10分钟时的疼痛评分显著低于硬膜外注射组。硬膜外注射组（127±40分钟）和鞘内注射组（110±48分钟）的平均镇痛持续时间相似。无患者出现任何运动阻滞。两组副作用相似，但鞘内注射组在5、10、15、20和30分钟时瘙痒的发生率和严重程度均显著更高。从给予镇痛药物到分娩的时间、手术或辅助分娩的发生率或再次给药时的宫颈扩张情况无差异。对于初产妇，在利多卡因试验剂量后硬膜外注射40微克舒芬太尼提供的镇痛效果与鞘内注射10微克舒芬太尼相当，但瘙痒较少。
我们比较了鞘内注射舒芬太尼与硬膜外注射舒芬太尼加局部麻醉试验剂量用于分娩镇痛的疗效和副作用。镇痛效果同样良好，尽管鞘内注射组瘙痒更多。
