罗比卡因硬膜外分娩镇痛的临床研究

目的:研究低浓度罗比卡因病人自控硬膜外镇痛(PCEA)行分娩镇痛的效果.方法:选择109例ASAⅠ～Ⅱ级、头位、单胎足月妊娠的初产妇行PCEA(分娩镇痛组).另选100例条件相仿但不给予硬膜外阻滞的自然分娩产妇为对照组.分娩镇痛组给予0.1%罗比卡因+芬太尼(1μg/ml),PCEA基础注药速率为6ml/h,冲击量为2ml,锁定时间为10分钟.进行视觉模拟镇痛评分(VAS)和下肢运动神经阻滞评分(MBS).记录产程时间、生产方式.监测胎儿心率(FHR)、新生儿Apgar评分和SpO2.结果:分娩镇痛组用药后15～30分钟均感到无痛或只感到轻度可耐受的疼痛(VAS评分0.6±0.8).分娩镇痛组产妇MBS在镇痛前后无统计学差异(P＞0.05),所有产妇均能下床活动.分娩镇痛组产妇第一产程时间为464.9±173.5分钟,短于对照组第一产程时间(P＜0.05).分娩镇痛组第二产程时间为48.4±21.8分钟,对照组为46.7±20.6分钟,两组无统计学差异(P＞0.05).分娩镇痛组新生儿1、5分钟Apgar评分和SpO2与对照组无统计学差异(P＞0.05).结论:低浓度罗比卡因分娩镇痛效果确切,对运动神经阻滞轻,不影响产程及新生儿,是目前分娩镇痛较理想的方法.     

罗哌卡因-芬太尼用于硬膜外和腰-硬联合阻滞分娩镇痛效果及安全性

目的比较罗哌卡因-芬太尼用于硬膜外阻滞(CEA)和腰-硬联合阻滞(CSEA)行分娩镇痛的临床效果及安全性。方法自愿接受分娩镇痛足月、单胎、头位初产妇40例,宫口扩张3～5cm时随机分为CEA组和CSEA组;无分娩镇痛的产妇为对照组(C组)。CEA组以0.1%罗哌卡因+芬太尼(2μg/ml)5ml为试验剂量,随后注入上述药物10ml。CSEA组蛛网膜下腔给予罗哌卡因2mg+芬太尼10μg。两组采用0.1%罗哌卡因+芬太尼2μg/ml硬膜外PCA。记录镇痛评分、下肢肌力、产程、分娩方式、药物用量、产妇满意度和新生儿1、5minApgar评分、脐带血罗哌卡因浓度。结果镇痛后5～30min,CSEA组VAS显著低于CEA组(P0.05);CSEA组罗哌卡因及芬太尼用量较CEA组明显减少(P0.05);两组脐带血罗哌卡因浓度差异无统计学意义。CSEA组和CEA组第一产程短于C组(P0.05)。与C组比较,CSEA组和CEA组自然分娩率较高,催产素使用率较高(P0.05)。与CEA组比较,CSEA组镇痛起效时间较短、催产素使用率较低,自然分娩率和产妇满意度更高(P0.05)。结论罗哌卡因-芬太尼用于CSEA和CEA均能提供满意且安全的分娩镇痛。CSEA因起效快、药物用量少、产妇满意度高而更适合分娩镇痛。     

不同浓度罗比卡因伍用芬太尼用于硬膜外分娩镇痛

目的　采用不同浓度的罗比卡因伍用小剂量芬太尼作硬膜外分娩镇痛 ,探讨较适宜的药物浓度 (RP)。方法　选择足月、单胎头位初产妇 12 0例 ,ASAⅠ～Ⅱ级 ,随机分成四组 ,每组 30例。所用药物 :A组 0 0 75 %罗比卡因 ;B组 0 12 5 %罗比卡因 ;C组 0 2 %罗比卡因 ,每组均加 2 μg/ml芬太尼 ;D组为对照组 ,未行分娩镇痛 ,于产程进展宫口开 3cm时 ,行硬膜外腔穿刺置管 ,首次剂量 8～ 12ml;30min后 ,连接PCA泵 ,维持量为 5～ 12ml/h持续硬膜外腔输注至宫口开全停药 ,PCA剂量 4ml,锁定时间 2 0min。用视觉模拟评分 (VAS)和改良Bromage评分评估镇痛、运动神经阻滞情况 ,观察记录各组产妇的生命体征、产程时间、分娩方式及新生儿Apgar评分。 结果A、B、C与D组相比 ,产妇用药后VAS评分均明显降低 ,且A、B、C组第一产程均较对照组明显缩短 (P <0 0 1)。但A组的镇痛效果欠佳 ,VAS评分高于B、C组 (P <0 0 1)。C组的难产率较高 ,与对照组相比有显著差异 (P <0 0 1)。B组镇痛效果最满意。宫口扩张速度和胎头下降速度较快 ,分娩中产妇的BP、HR、RR平稳 ,对产程和分娩方式及新生儿Apgar评分均无明显影响 ,联合用药可减少局麻药用量。结论　 0 12 5 %罗比卡因伍以芬太尼用于硬膜外分娩镇痛对产程影响小 ,镇痛效果确     

腰-硬联合阻滞腰麻后硬膜外镇痛时机对分娩镇痛的影响

目的观察腰-硬联合阻滞(CSEA)腰麻后硬膜外镇痛时机对分娩镇痛的影响。方法选择ASAⅠ或Ⅱ级,足月初产妇80例,于宫口开至2~3cm时实施CSEA镇痛。将入选产妇采用随机数字表法均分为E1组、E2组、E3组和E4组,分别于蛛网膜下腔给药后3、30、60和90min接受持续硬膜外给药。L3~4椎间隙行硬膜外穿刺,取25G腰麻穿刺针刺入蛛网膜下腔,见脑脊液后给予布比卡因2.5mg和芬太尼25μg,然后均采用PCEA模式。0.1%罗哌卡因与2μg/ml芬太尼混合液100ml加入电子镇痛泵,设置背景维持量为10ml/h,单次剂量为5ml,锁定时间15min。记录第一产程时间、第二产程时间、催产素使用率、分娩方式和不良反应发生情况,新生儿Apgar评分、脐动脉血气分析,以及产妇补救剂量和硬膜外用药总量。结果四组产妇产程、催产素使用率、分娩方式、新生儿Apgar评分、脐动脉血气分析差异均无统计学意义。E1、E2组需要PCA例数和次数明显少于、硬膜外罗哌卡因补救剂量明显低于E3、E4组(P<0.05)。结论蛛网膜下腔给药后30min以内开始硬膜外持续镇痛可以明显减少PCA次数和硬膜外罗哌卡因的补救剂量。     

罗哌卡因复合舒芬太尼连续蛛网膜下腔阻滞用于全产程分娩镇痛的临床效果

目的观察罗哌卡因复合舒芬太尼连续蛛网膜下腔阻滞用于全产程分娩镇痛的效果。方法选择2018年3-10月在北京妇产医院全产程分娩镇痛的足月妊娠单胎头位初产妇97例,年龄23~35岁,体重60~90 kg,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:连续蛛网膜下腔阻滞组(CSA组,n=48)和腰-硬联合阻滞组(CSEA组,n=49)。产妇子宫规律收缩后行分娩镇痛,CSA组经蛛网膜下腔推注罗哌卡因0.3 mg/ml+舒芬太尼1μg/ml共5 ml,20 min后连接镇痛泵;CSEA组经蛛网膜下腔推注罗哌卡因0.3 mg/ml+舒芬太尼1μg/ml共5 ml,20 min后连接硬膜外镇痛泵。所有产妇持续应用镇痛泵至第三产程结束。记录镇痛即刻(T1)、镇痛后10 min(T2)、30 min(T3)、60 min(T4)、宫口开全(T5)、胎头娩出(T6)、胎盘娩出(T7)时的MAP和VAS疼痛评分;记录镇痛前、镇痛后0~30 min、30~60 min、90~120 min和第二产程的宫缩持续时间和宫缩间隔时间;记录缩宫素使用情况和分娩方式;记录恶心呕吐、瘙痒、产后出血和硬脊膜穿刺后头痛(PDPH)的发生情况;记录新生儿体重、出生后1、5、10 min Apgar评分和脐带动脉血血气分析。结果与CSEA组比较,T2、T5、T6时CSA组MAP和VAS疼痛评分明显降低(P<0.05);镇痛后0~30 min CSA组宫缩持续时间明显缩短(P<0.05),宫缩间隔时间明显延长(P<0.05)。CSA组缩宫素使用率、瘙痒发生率明显高于CSEA组(P<0.05)。两组分娩方式以及恶心呕吐、产后出血、PDPH发生率差异无统计学意义。两组新生儿体重、出生后1、5、10 min Apgar评分和脐带动脉血血气分析差异无统计学意义。结论与腰-硬联合阻滞比较,连续蛛网膜下腔阻滞具有用药量小的特点,对产妇、胎儿影响较小,可安全用于全产程分娩镇痛。     

罗哌卡因和布比卡因在分娩镇痛中应用效果比较

目的:对比低浓度罗哌卡因和布比卡因用于分娩镇痛的效果。方法:取条件相同能经阴道分娩的ASA分级Ⅰ 级足月妊娠产妇30例,随机分为A、B两组,A组为0.1％罗哌卡因+3ug·ml-1芬太尼组,B组为0.1％的布比卡因+3ug·ml-1芬太尼组。采用双盲法进行视觉摸拟疼痛评分(VAS)和下肢运动神经阻滞评分(MBS)。记录产程、生命体征、分娩方式和新生儿Apgar评分。结果:两组产妇分娩镇痛效果良好且无显著性差异(P>0.05)。MBS评分A组15例(100％)均为6分,所有产妇均能下床行走和自主排尿,而B组仅10例(67％)为6分,即67％的产妇能下床行走和自主排尿,两组比较有显著性差异(P<0.05)。比较两组产程、新生儿Apgar评分均无显著性差异(P>0.05)。结论:低浓度罗哌卡因用于硬膜外分娩镇痛效果优于等浓度布比卡因。     

硬膜外低浓度布比卡因缓解分娩疼痛

目的　观察低浓度布比卡因硬膜外阻滞缓解分娩疼痛的效果。方法　根据随机分组 原则,200例足月产妇接受0.125%布比卡因(A组),185例足月产妇接受含芬太尼2μg/ml的 0.125%布比卡因的硬膜外阻滞组(B组),156例足月产妇不作镇痛作为对照组(C组)。在宫口至2 ～3cm时两观察组经L3～4硬膜外穿刺向头端置管成功,经5ml1.5%的利多卡因试验后,均一次性 注射10ml相应局麻药,30min后接各自局麻药以5ml/h持续输入。采用视觉模拟评分(VAS)和改 良Bromage法记录疼痛分数和下肢运动阻滞分级。记录产妇生命体征、产程时间、催产素使用量、器 械助产、产后出血量及胎心宫缩图和新生儿出生1、5min的Apgar评分。结果　两观察组镇痛效果 差异有极显著性(P<0.01),三组在活跃期VAS评分分别为:A组(3.85±0.64)分,B组(3.67± 0.62)分,C组(8.98±1.41)分。运动阻滞两观察组均以1级为主,全部能自主或在护士搀扶下行 走。两观察组第一产程活跃期明显短于C组(P<0.05)。三组借助器械分娩,分别为9%、9.7%和 8.3%。催产素用量两观察组明显多于C组(P<0.05),且以B组最多。产后失血量两观察组稍多 于C组(P>0.05)。新生儿Apgar评分三组相似。结论　0.125%布比卡因持续硬膜外阻滞能提供 满意的分娩镇痛,并促进活跃期,无明显副作用。此浓度局麻     

不同穿刺点硬膜外镇痛分娩效果比较

目的探讨不同穿刺点硬膜外镇痛分娩的效果。方法将 12 0例单胎足月初产妇随机分为两组各 6 0例。观察组以L1～L2 为穿刺间隙 ,对照组为L3 ～L4。两组镇痛方法、所用药物及浓度相同。观察两组镇痛药首剂量、起效时间 ,PCA次数 ,VAS评分 ,运动神经阻滞评分 ,第一、二产程时间 ,分娩方式 ,新生儿Apgar评分 ,产后 2h出血量等指标。结果VAS评分、运动神经阻滞程度、新生儿Apgar评分、产后 2h出血量两组比较 ,差异无显著性意义(均P >0 .0 5 ) ;其余项观察组均优于对照组 (均P <0 .0 5 )。结论L1～L2 间隙穿刺硬膜外镇痛分娩 ,有良好的镇痛效果 ,可缩短产程 ,提高自然分娩率。     

不同浓度罗哌卡因用于全产程硬膜外分娩镇痛的疗效观察

目的比较不同浓度罗哌卡因用于不同产程硬膜外分娩镇痛的效果。方法选择要求硬膜外分娩镇痛的初产妇360例,随机分为3组(n=120)。所有患者在完成硬膜外腔置管后,硬膜外腔注射负荷剂量局麻药(0.1%罗哌卡因+2μg/ml芬太尼),阻滞平面达T_(10)后接PCA泵行PCEA。A组PCA采用0.1%罗哌卡因+2μg/ml芬太尼,宫口开全时停止PCA。B组PCA采用0.1%罗哌卡因+2μg/ml芬太尼全产程镇痛。C组PCA采用0.08%罗哌卡因+2μg/ml芬太尼全产程镇痛。观察产妇镇痛前(T_0)、镇痛后1小时(T_1)、2小时(T_2)、3小时(T_3)、宫口开全时(T_4)、分娩时(T_5)、会阴部修复时(T_6)VAS评分;采用Bromage评分评价运动阻滞程度;记录产程时间、镇痛时间、分娩方式、新生儿Apgar评分、满意度评分及不良反应的发生情况。结果与T_0时比较,B、C两组产妇T_1~T_6时点VAS评分较低,A组T_1~T_5时点VAS评分较低(P0.05)。与A组比较,B、C两组产妇T_6时点VAS评分较低;产妇对分娩镇痛效果满意度较高(P0.05)。3组产妇第一产程时间、第一产程镇痛时间、第二产程时间、分娩方式、新生儿Apgar评分、Bromage评分及不良反应差异无统计学意义(P0.05)。结论全产程硬膜外分娩镇痛效果优于第一产程分娩镇痛,而0.08%罗哌卡因复合芬太尼用于全产程分娩镇痛具有较好的效果与安全性。     

腰麻联合双管硬膜外分娩镇痛的临床效果

目的评估腰麻联合双管硬膜外分娩镇痛的效果及对母婴的影响。方法 2015年4月至2016年1月于本院要求分娩镇痛的初产妇129例,随机分为两组。D组(n=68)腰麻后双管硬膜外阻滞分娩镇痛,S组(n=61)腰麻后单管硬膜外阻滞分娩镇痛。记录镇痛前(T0)及镇痛后10min(T1)、30 min(T2)、120 min(T3)、宫口开至7~8 cm(T4)、宫口开全(T5)、第二产程用力分娩时(T6)的VAS疼痛评分,各产程时间及缩宫素使用情况,镇痛泵按压及镇痛药物使用情况,分娩方式,产时出血量,新生儿情况和镇痛不良反应。结果 T0~T4时两组VAS评分差异无统计学意义,T5、T6时D组VAS评分明显低于S组(P0.05)。镇痛泵有效按压次数及镇痛药物使用量两组差异无统计学意义,但镇痛泵总按压次数D组明显少于S组(P0.05)。各产程时间、缩宫素使用率、分娩方式、产时出血量、新生儿情况和镇痛不良反应两组差异均无统计学意义。结论腰麻联合双管硬膜外分娩镇痛效果确切,不良反应少,产妇满意度高,对母婴是安全的。     

硬膜外分娩镇痛的研究进展

硬膜外分娩镇痛对分娩的影响一直存在争议.新近资料不仅提供了硬膜外分娩镇痛对产程、剖宫产率、阴道器械助产率、及新生儿影响的进展,而且它与持续性枕后位和产妇发烧的关系也受到关注.改进硬膜外分娩镇痛技术的关键是减小对分娩不利影响并保证产妇满意镇痛的重要手段.研究表明采用低浓度局麻药复合阿片类药硬膜外镇痛,设置大容量PCEA和长锁定时间的输注模式对分娩的影响最小.     

腹部手术后镇痛药需求量的影响因素

目的：分析腹部手术后患者自控静脉镇痛用药量的影响因素。方法选取2012年4月至2013年8月全麻下行腹部手术,术后接受48 h自控静脉镇痛的患者。记录患者性别、年龄、身高、体重、体重指数、手术方式、手术部位。术后静脉镇痛期间,记录用药剂量、静止和运动疼痛评分、镇静评分、心率、血压、脉搏氧饱和度以及不良反应。采用多元线性回归分析多个变量与用药量的关系。结果共有2829例（男性1611例,女性1218例）患者纳入分析。性别、年龄、体重和手术部位显著影响术后镇痛用药量。其中,体重影响最大且与术后镇痛用药量正相关,年龄与术后镇痛用药量负相关,女性用药量少于男性。身高、体重指数和手术方式不是术后镇痛用药量的决定因素。结论腹部手术患者实施术后自控静脉镇痛时要考虑体重、年龄、性别以及手术部位的影响,为患者制定专科化和个体化的镇痛方案。     

开胸手术后伤口持续输注局麻药和PCIA的镇痛效果

目的比较开胸手术后伤口持续输注局麻药和PCIA的镇痛效果。方法择期开胸非心脏手术患者60例,ASAⅠ或Ⅱ级,随机均分为两组:伤口持续输注局麻药镇痛组(A组)和PCIA组(B组)。A组患者缝皮前在切口皮下处放置镇痛泵导管,继之通过导管快速给予0.5%罗哌卡因5ml,术毕48h内以2ml/h持续输注0.5%罗哌卡因。B组患者手术结束前30min缓慢静注舒芬太尼3μg,术毕接PCA泵以2ml/h(3μg/kg舒芬太尼配置成100ml)持续泵注。分别记录患者术后2、8、12、24、36、48h安静和活动时VAS评分、Ramsay镇静评分、术后需哌替啶镇痛例数、不良反应、住院时间及总体满意率等。结果两组患者术后不同时点安静时和活动时VAS评分差异无统计学意义。与A组比较,术后不同时点A组Ramsay镇静评分明显升高(P0.05)。术后A组无一例患者发生不良反应,明显低于B组嗜睡26例(87%)、头晕11例(37%)(P0.05)、呼吸抑制2例(6%)。A组满意率29例(97%),B组25例(83%),患者术后需哌替啶镇痛A组8例(26.7%),B组7例(23.3%),两组差异均无统计学意义。结论伤口持续输注局麻药镇痛和PCIA具有同样的镇痛效果,但伤口持续输注局麻药镇痛不良反应发生率低。     

Analgesia combinada epidural-intradural para el trabajo de parto: una revisión bibliográfica sistemática cuantitativa (metaanálisis)

ObjectiveTo perform a meta-analysis on the use of combined epidural-intrathecal analgesia during labor, including intrathecal fentanyl and/or morphine compared to usual epidural techniques.Material and methodA literature search was made looking for randomized clinical trials in MEDLINE, EMBASE and Cochrane Library. The size of the effect for quantitative variables was analyzed by weighted mean difference; for qualitative variables, by odds ratio. Variables analyzed were: labor duration, type of delivery (spontaneous, instrumental and caesarean section), motor blockade, pain, and satisfaction. The analysis used in most cases was a random effects model.ResultsA total of 21 trials, which included 3.646 patients, were selected out of the 38 initially found. The type of delivery variable with its 3 subgroups was the only one to show uniformity (p > Q 0.1; I² < 50%). There were no differences in the variables analyzed except pain, which was advantageous for the group with intrathecal fentanyl or morphine by 0.55 points out of 10.ConclusionCombined analgesia including intrathecal fentanyl-morphine does not offer significant advantages compared to the standard epidural.     

Postoperative analgesia after major abdominal surgery: Fentanyl–bupivacaine patient controlled epidural analgesia versus fentanyl patient controlled intravenous analgesia

BackgroundMajor abdominal surgeries induce neurohumoral changes responsible for postoperative pain, various organ dysfunctions and prolonged hospitalization. Inadequate pain control is harmful and costly to patients thus an appropriate pain therapy to those patients must be applicated.MethodsOne hundred patients (ASA I or II) of either sex aged from 20 to 60 years were scheduled for elective major abdominal surgery. Patients were allocated randomly into two groups (fifty patients each) to receive: patient-controlled epidural analgesia with bupivacaine 0.125% and fentanyl (PCEA group), or patient controlled intravenous analgesia with fentanyl (PCIA group). Postoperative pain was assessed over 24 h using Numerical Pain Rating scale (NPRS). The frequency of rescue analgesia, sedation score and overall patient satisfaction were recorded. Any concomitant events like nausea; vomiting, shivering, pruritus or respiratory complications were recorded postoperatively.ResultsThere was a significant less pain in PCEA group at 2, 8 and 12 h. postoperative but PCIA group had less pain at immediate postoperative time. As regard sedation scale, patients of the PCEA group were significantly less sedated than PCIA group at immediate postoperative only. Overall patient satisfaction was significantly more in PCEA group.ConclusionThis study concluded that both PCEA and PCIA were effective in pain relief after major abdominal surgery but PCEA was much better in pain relief, less sedating effect and overall patient satisfaction.     

Comparison of patient-controlled epidural analgesia with and without night-time infusion following gastrectomy

To assess the analgesic efficacy and side effects of a supplementalnight-time infusion in patient-controlled epidural analgesia(PCEA) after gastrectomy, we carried out a randomized, double-blindstudy. The number of requests were lower (P<0.005) in thePCEA plus night-time infusion group than in the PCEA alone groupduring the postoperative nights. Patients who had a PCEA plusnight-time continuous infusion, slept with fewer interruptionsthan those who had only the PCEA. VAS pain scores on coughingwere significantly lower (P<0.05) in the PCEA plus infusiongroup than in the PCEA alone group during the night followingpostoperative day 1. In conclusion, a night-time infusion inPCEA following gastrectomy decreases the incidence of postoperativepain, provides a better sleep pattern, and reduces the degreeof the pain associated with coughing during the night. Br J Anaesth 2001; 87: 633–5     

瑞芬太尼静脉自控镇痛与腰-硬联合镇痛用于分娩镇痛的比较

目的比较瑞芬太尼静脉自控镇痛(PCIA)与罗哌卡因复合芬太尼腰-硬联合自控镇痛(CSEA)在分娩镇痛中的安全性和有效性。方法选择单胎足月初产妇60例,年龄22～32岁,身高156～170cm,体重60～75kg,ASAⅠ级,依据产妇自愿原则分为两组:瑞芬太尼静脉自控镇痛组(R组)和罗哌卡因复合芬太尼腰-硬联合自控镇痛组(E组),每组30例。R组瑞芬太尼背景剂量0.02μg·kg~(-1)·min~(-1),单次剂量10～20μg,锁定时间3min;E组蛛网膜下腔注射罗哌卡因2.5～3mg,然后连接硬膜外镇痛泵(0.1%罗哌卡因75ml+芬太尼2μg/ml),设置负荷剂量10ml,背景剂量8～10ml/h,单次剂量为5ml,锁定时间15min。记录产妇镇痛前、镇痛后30min的SBP、HR、SpO2;记录镇痛前、镇痛后30min和宫口开全时VAS疼痛评分、改良Bromage评分、Ramsay镇静评分;记录第一产程和第二产程时间、胎心率、新生儿Apgar评分及脐动脉血气;分析不良反应情况、产妇满意度。结果 R组VAS疼痛评分及Ramsay镇静评分明显高于E组(P0.05);R组头晕发生率明显高于E组(P0.05);两组产程时间、Bromage评分、恶心呕吐、嗜睡、皮肤瘙痒、尿潴留等不良反应情况、产妇满意度、胎心率、脐动脉血气分析及新生儿Apgar评分差异无统计学意义。结论与罗哌卡因复合芬太尼腰-硬联合自控镇痛比较,采用瑞芬太尼静脉自控镇痛有较好的镇痛效果。尽管产妇镇静深度更高,头晕发生率较多,但是对母婴无明显不良反应,可作为椎管内分娩镇痛的补充方法。     

个体化镇痛时机对硬膜外分娩镇痛效果的影响

目的观察提前预置硬膜外导管,根据产妇需要开始镇痛的个体化镇痛模式对分娩镇痛效果的影响。方法这是一项标签开放的随机对照研究。选择单胎、足月、头位妊娠初产妇,年龄18~35岁,随机分为两组。个体化组产妇在产程开始(出现规律宫缩、宫颈接近消失)行硬膜外穿刺置管,当产妇有镇痛需求且NRS评分≥5分时给予硬膜外镇痛;对照组在宫口开大1 cm时行硬膜外镇痛。主要研究终点是分娩过程最严重疼痛NRS评分及分娩时NRS评分≥7分产妇比例。结果194例产妇完成研究,分娩过程中两组最严重疼痛程度NRS评分[个体化组9(8~10)分vs对照组9(8~10)分,P=0.201]及分娩时NRS评分≥7分产妇比例[个体化组94例(96.9%)vs对照组89例(91.8%),P=0.121]差异均无统计学意义。两组不良事件发生率差异无统计学意义。结论对于单胎、足月、头位且产科评估可试行阴道分娩的产妇,根据产妇需求实施硬膜外分娩镇痛的效果与传统的镇痛时机(宫口开放1 cm)相当。     

Comparison of patient-controlled analgesia with and without a background infusion after appendicectomy in children

BACKGROUND: There have been many studies using patient-controlled analgesia (PCA) and opioids for postoperative analgesia in children. In this study, we investigated the efficacy, usefulness and analgesic consumption of two different PCA programmes [bolus dose alone (BD) or bolus dose with background infusion (BD + BI)] to evaluate postoperative analgesia for children after emergency appendicectomy. METHODS: Forty children, aged between 6 and 15 years and ASA class I or II, undergoing emergency appendicectomy were randomly allocated into two groups. The children were given a loading dose of pethidine 0.3 mg.kg-1 and 150 micro g.kg-1 bolus intravenously in group BD (n = 20) and pethidine 0.3 mg.kg-1 loading dose, 75 micro g.kg-1 bolus and 15 micro g.kg-1.h-1 background infusion in group BD + BI (n = 20). The lockout interval was 20 min in both groups. RESULTS: There were no significant differences in pain, sedation and nausea scores during the 24-h postoperative period between the groups (P > 0.05). Pethidine consumption was significantly lower in group BD + BI than that in group BD for the first 24-h period (P < 0.05). CONCLUSIONS: We demonstrated that both these PCA programmes were effective and reliable for postoperative pain relief in children. We believe that giving information about PCA to the children and their parents is useful during the preoperative period. However, the background infusion with lower bolus dose in PCA did not increase pethidine consumption.     

Labour analgesia by single shot spinal for any parturient?—A retrospective one-year single centre audit

Background

Single shot spinal (SSS) provides effective analgesia for multiparous parturients during advanced labour. Its utility in early labour or primiparous parturients may be limited by the insufficient duration of action. Regardless, SSS may offer a reasonable labour analgesia option in certain clinical scenarios. In this retrospective study, we analyse the failure rate of SSS analgesia by assessing pain after the SSS and by determining the need for additional analgesic interventions in primiparous or early-stage multiparous parturients compared to multiparous parturients in advanced labour (cervix ≥6 cm).

Methods

Following institutional ethical board approval, the patient files of all parturients receiving SSS analgesia during a 12-month period in a single centre were analysed for any recorded notes regarding recurrent pain or subsequent analgesia interventions (a new SSS, epidural, pudendal or paracervical bloc) as a marker for insufficient analgesia.

Results

A total of 88 primiparous and 447 multiparous parturients (cervix <6 cm: N = 131; cervix ≥6 cm: N = 316) received SSS analgesia. The odds ratio for the insufficient duration of analgesia was 1.94 (1.08–3.48) in primiparous and 2.08 (1.25–3.46) in early-stage multiparous parturients compared to advanced multiparous labour (p < .01). Primiparous and early-stage multiparous parturients were also 2.20 (1.15–4.20) and 2.61 (1.50–4.55) times more likely, respectively, to receive new peripheral and/or neuraxial analgesic interventions during delivery (p < .01).

Conclusions

SSS appears to provide adequate labour analgesia for the majority of parturients in whom it is used, including nulliparous and early-stage multiparous parturients. It remains a reasonable option in certain clinical scenarios, including resource-limited settings where epidural analgesia is unavailable.