纳布啡减少罗哌卡因用于硬膜外分娩镇痛的剂量:一项随机、双盲、对照研究

目的:探讨纳布啡混合罗哌卡因用于硬膜外分娩镇痛的作用。方法:选取2019年10月至2021年2月复旦大学附属妇产科医院收治的产妇104例。采用随机数字表将104例产妇随机分为纳布啡组(N组,n=52)和罗哌卡因组(L组,n=52)。选择L_(2-3)间隙进行硬膜外穿刺,穿刺成功并平卧后给予试验剂量。给药方法:N组,硬膜外注射0.1%罗哌卡因+0.3 mg/mL纳布啡混合液10 mL,给药30 min后以相同浓度混合液行患者自控硬膜外镇痛,背景剂量6 mL/h,患者自控镇痛(patient controlled analgesia, PCA)剂量为6 mL,锁定时间为15 min; L组除了不使用纳布啡外,其余药物和镇痛步骤与N组相同。记录镇痛起效时间、首次PCA时间、各时点视觉模拟评分(visual analogue scale, VAS)及不良反应,记录药物总消耗量及新生儿Apgar评分。结果:与L组首次PCA时间(71.7±41.4) min]比较,N组首次PCA时间延长(102.4±73.1) min,P=0.013],起效时间缩短(21.6±7.9)min vs(17.2±8.6)min,P=0.009)]。N组罗哌卡因单位时间用量低于L组(10.4±3.6) mg vs(12.8±4.7) mg,P=0.004)]。与L组比较,N组PCA按压次数和有效按压次数均降低(P=0.045、0.003)。2组间产科结局相似。结论:0.3 mg/mL纳布啡混合罗哌卡因用于硬膜外分娩镇痛可降低单位时间罗哌卡因用量,提供满意的镇痛效果,且不良反应少,是可行的镇痛方案。

Nalbuphine reduces the dose of ropivacaine for epidural labor analgesia: a randomized, double-blind, controlled study

Objective: To explore the effect of nalbuphine mixed with ropivacaine on epidural labor analgesia. Methods: From October 2019 to February 2021, 104 cases of puerpera from Obstetrics and Gynecology Hospital, Fudan University were selected. 104 parturients were randomly divided into two groups:nalbuphine group (N group, n=52) and ropivacaine group (L group, n=52).The L2-3 space was selected for epidural puncture, and the test dose was given after successful puncture and supine. In group N, a mixture of 10 mL of 0.1% ropivacaine + 0.3 mg/mL nalbuphine was injected epidural. After 30 min, patient-controlled epidural analgesia was performed with the same concentration mixture, with background dose of 6 mL/h, patient-controlled-analgesia (PCA) dose of 6 mL and locking time of 15 min. Except that no nalbuphine was used in group L, other drugs and analgesic procedures were the same as those in group N. The analgesic onset time, first PCA time, visual analogue scale (VAS) score, analgesic adverse reactions were recorded. After analgesia, the total drug consumption and Apgar score of newborn were recorded. Results: Compared with the first PCA time in group L (71.7±41.4) min, the first PCA time in group N (102.4±73.1) min was prolonged (P=0.013) and the onset time was shortened(21.6±7.9) min vs (17.2±8.6) min, P=0.009)]. The consumption per hour of ropivacaine in group N (10.4±3.6) mg was lower than that in group L(12.8±4.7) mg, (P=0.004). Compared with group L, the number of PCA compression (P=0.045) and effective compression (P=0.003) in group N decreased. The obstetric outcomes were similar between the two groups. Conclusions: 0.3 mg/mL nalbuphine mixed with ropivacaine could reduce the dosage of ropivacaine per unit time, provide satisfactory analgesic effect, and have few adverse reactions, so it may be an optional analgesic scheme for epidural labor analgesia.