罗比卡因和布比卡因用于自控硬膜外分娩镇痛的临床效果对比研究

目的 :比较罗比卡因和布比卡因联合芬太尼用于自控硬膜外分娩镇痛 (PCEA)的效果及运动神经阻滞情况。方法 :将 6 0例健康、单胎、足月的初产妇随机分为两组 ,接受 0 .1%罗比卡因加 1μg/ml芬太尼 (RF组 )或 0 .0 75 %布比卡因加 1μg/ml芬太尼 (BF组 )自控硬膜外分娩镇痛。两组进行视觉模拟镇痛评分 (VAS)和下肢运动神经阻滞评分(MBS)。记录两组产程时间、分娩方式、阴道流血量及新生儿Apgar评分。结果 :两组产妇均有较可靠的镇痛效果 ,差异无显著性 (P >0 .0 5 ) ;RF组可下床活动者为 96 .6 7% ,而BF组为 33.33% ,两组差异有显著性 (P <0 .0 5 ) ;两组产程时间和分娩方式差异无显著性 (P >0 .0 5 ) ;两组新生儿Apgar评分差异无显著性 (P >0 .0 5 )。结论 :低浓度罗比卡因或布比卡因联合小剂量芬太尼用于PCEA均可产生可靠的镇痛效果。产程中罗比卡因极少引起运动阻滞 ,产妇有下床活动能力 ,其效果优于布比卡因

Comparative Study of Ropivacaine and Bupivacaine for Epidural Labor Analgesia

Objective:To compare the analgesia efficacy and degree of motor blockade by using PCEA administration of ropivacaine plus fentanyl to that of bupivacaine plus fentanyl during labor.Methods:60 heathy nulliparous women in active labor ( weight<100 kg, heigh>150 cm, gestational age 37 to 42 weeks) who requested epidural analgesia were enrolled in a randomized controlled clinical study. Parturients were randomly allocated to receive epidural 0.1% ropivacaine plus 1ug/ml fentanyl (group RF) or 0.075% bupivacaine plus 1ug/ml fentanyl(group BF). Pain intensity and motor blockade were assessed on a visual analog scale(VAS), and a modified Bromage scale(MBS) at different moments. The duration of labor, mode of final delivery and neonatal Apgar scores were also recorded. Results: Both of groups were offered reliable analgesia throughout labor, the VAS had no significant differences between the two groups (P>0.05). Ambulation was observed in 96.67% (29 of 30) of RF group compared with 33.33% ( 10 of 30 ) of BF group . The degree of motor blockade in RF group was lower than that of BF group (P<0.05). There were no significant differences in the duration of labor, mode of delivery, and neonatal Apgar scores between two groups.Conclusions:Both of low concentration ropivacaine and bupivacaine combined with small dose of fentanyl are highly effective for labor analgesia by using PCEA. Ropivacaine can preserve the ability of the women to ambulate with minimal motor blockade during labor.