舒芬太尼对布比卡因用于分娩硬膜外镇痛时最低局部镇痛浓度的剂量依赖性降低作用。

Dose-dependent reduction of the minimum local analgesic concentration of bupivacaine by sufentanil for epidural analgesia in labor.

作者信息

Polley L S, Columb M O, Wagner D S, Naughton N N

机构信息

Department of Anesthesiology, Women's Hospital, University of Michigan Medical Center, Ann Arbor, USA.

出版信息

Anesthesiology. 1998 Sep;89(3):626-32. doi: 10.1097/00000542-199809000-00011.

DOI:10.1097/00000542-199809000-00011

PMID:9743398

Abstract

BACKGROUND

The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the local anesthetic-sparing efficacy of epidural sufentanil by its effect on the MLAC of bupivacaine.

METHODS

In this double-blind, randomized, prospective study, 147 parturients at < or = 7 cm cervical dilation who requested epidural analgesia were allocated to one of four study groups. After a lumbar epidural catheter was placed, study participants received 20 ml bupivacaine (n = 38), bupivacaine with sufentanil 0.5 microg/ml (n = 38), bupivacaine with sufentanil 1 microg/ml (n = 33), or bupivacaine with sufentanil 1.5 microg/ml (n = 38). The concentration of bupivacaine was determined by the response of the previous patient using up-down sequential allocation. The analgesic efficacy was assessed using 100-mm visual analog pain scores, with < or = 10 mm within 30 min defined as effective.

RESULTS

The MLAC of bupivacaine alone was 0.104% wt/vol (95% CI, 0.090-0.117). The addition of sufentanil at doses of 0.5 microg/ml, 1 microg/ml, and 1.5 microg/ml resulted in significant reductions (P < 0.0001) in the MLAC of bupivacaine to 0.048% wt/vol (95% CI, 0.030- 0.065), 0.021% wt/vol (95% CI, 0-0.055), and 0.009% wt/vol (95% CI, 0-0.023), respectively.

CONCLUSIONS

This study showed a significant (P < 0.0001) dose-dependent reduction in the MLAC ofbupivacaine by sufentanil.

摘要

背景

最小局部镇痛浓度（MLAC）被定义为分娩第一阶段硬膜外镇痛20毫升容积中的中位有效局部镇痛浓度。本研究的目的是通过舒芬太尼对布比卡因MLAC的影响来确定其节省局部麻醉药的效果。

方法

在这项双盲、随机、前瞻性研究中，147名宫颈扩张≤7厘米且要求硬膜外镇痛的产妇被分配到四个研究组之一。放置腰段硬膜外导管后，研究参与者接受20毫升布比卡因（n = 38）、含0.5微克/毫升舒芬太尼的布比卡因（n = 38）、含1微克/毫升舒芬太尼的布比卡因（n = 33）或含1.5微克/毫升舒芬太尼的布比卡因（n = 38）。布比卡因的浓度根据前一位患者的反应采用序贯上下法确定。使用100毫米视觉模拟疼痛评分评估镇痛效果，30分钟内≤10毫米定义为有效。

结果

单独使用布比卡因的MLAC为0.104%重量/体积（95%可信区间，0.090 - 0.117）。添加0.5微克/毫升、1微克/毫升和1.5微克/毫升剂量的舒芬太尼后，布比卡因的MLAC显著降低（P < 0.0001），分别降至0.048%重量/体积（95%可信区间，0.030 - 0.065）、0.021%重量/体积（95%可信区间，0 - 0.055）和0.009%重量/体积（95%可信区间，0 - 0.023）。