低浓度小剂量罗比卡因复合芬太尼硬膜外分娩镇痛

本文观察低浓度小剂量罗比卡因复合芬太尼硬膜外分娩镇痛的临床效果。资料与方法将 30例无产科、麻醉禁忌证的初产妇 (观察组 ) ,在宫口开大 2～ 4ｃｍ时给于硬膜外麻醉 (Ｌ3～ 4 间隙穿刺 ,向头侧置硬膜外导管 3 5ｃｍ)。先注 1%利多卡因 3ｍｌ,观察 5分钟无脊麻阻滞和局麻药中毒征象后注射混合液 [0 1%罗比卡因+0 0 0 0 2 5 %芬太尼 (2 5 μｇ/ｍｌ) +1∶2 0万肾上腺素 ]3～5ｍｌ,感觉平面控制在Ｔ10 以下。当阻滞作用消退或镇痛不满意时追加 3～ 5ｍｌ。可重复追加。宫口开全后停止给药。另 30例条件相仿自然分娩初产妇作对照组。比较…     

0.1%罗哌卡因与0.1%布比卡因复合芬太尼硬膜外分娩镇痛

罗哌卡因是一种新型长效酰胺类局麻药 ,其化学结构与布比卡因相似 ,但对中枢神经及心血管毒性明显低于布比卡因[1] 。低浓度时 ,罗哌卡因对感觉和运动神经可呈分离阻滞[2 ] 。本研究拟观察小剂量罗哌卡因合并芬太尼硬膜外持续输注进行分娩镇痛的临床效果 ,并与相同浓度的布比卡因进行比较。资料与方法采用随机、双盲、对照、平行试验。对自愿接受无痛分娩的 6 0例名足月初产妇 ,年龄 2 1～ 31岁 ,ＡＳＡ分级 1～ 2级 ,随机分为 (1)试验组 :罗哌卡因组 (Ｒ组 )和 (2 )对照组 :布比卡因组 (Ｂ组 )。Ｒ组 ,负荷剂量 :罗哌卡因 10ｍｇ 0 1ｍｇ…     

不同浓度罗比卡因复合芬太尼硬膜外镇痛泵分娩镇痛的观察

我们将三种不同浓度罗比卡因复合芬太尼用于硬膜外持续镇痛泵分娩镇痛，现报道如下。     

不同浓度左旋布比卡因伍用芬太尼用于硬膜外分娩镇痛的临床观察

分娩疼痛不仅造成产妇痛苦，而且影响母婴平安。硬膜外分娩镇痛以其镇痛效果确切、简便易行，对产妇影响小广泛应用临床。硬膜外分娩镇痛既要有良好的镇痛效果又要尽可能地保留产妇的运动能力，因此镇痛液中局麻药浓度要适中。本研究拟对比观察不同浓度的左旋比布卡因伍用芬太尼用于硬膜外分娩镇痛，比较其镇痛效果和对产时产力的影响，找出适宜的左旋布比卡因浓度。     

经微量泵布比卡因复合芬太尼经硬膜外用于分娩镇痛

本研究观察以2ml／h的速度持续硬膜外腔输注含芬太尼2．5μg／ml的0．15％布比卡因，在分娩过程中的镇痛效果，以及对产程、宫缩强度、宫缩频率、胎儿心率、新生儿Apgar评分及产后出血量等因素的影响，综合评定该方法在临床的应用价值。     

低浓度布比卡因复合芬太尼用于产妇自控硬膜外分娩镇痛的临床观察

随着围产医学的发展和人们生活水平的提高,孕妇对分娩提出了更高的要求,分娩期间,在保证母婴安全的同时,更要求无痛.因此,减轻或消除分娩疼痛是产科临床亟待解决的重要课题[1].硬膜外分娩镇痛因其神经阻滞完善、镇痛效果确切,成为目前国内外广泛采用的分娩镇痛方法<'[2,3]>.     

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     

罗哌卡因复合芬太尼用于产妇自控硬膜外分娩镇痛的可行性

目的评价罗哌卡因复合芬太尼用于产妇自控硬膜外镇痛的可行性.方法ASA I～Ⅱ级初产妇足月单胎90例随机分为3组.30例为对照组,60例分为2组镇痛组A组(PCEA-LP)0.2%罗哌卡因复合芬太尼2μg/ml负荷量10ml,当VAS≥20mm时,自控给药4ml/次,锁定时间为15min.B组(PCEA-LCP)相同药物负荷量10ml,半小时后背景量4ml/h,当VAS≥20mm给药4ml/次,锁定时间为15min,直到宫口开全停药.连续监测呼吸循环状况,评估镇痛效应和运动阻滞的程度,观察记录产程进展,采集静脉血测血浆儿茶酚胺浓度,观察不良反应及新生儿情况.结果新生儿评分,脐带静脉血血气分析,活跃期及第Ⅱ产程时间3组无显著差异.A、B两组间VAS疼痛评分,感觉阻滞,运动阻滞程度,NE,E浓度和剖宫产率无差别.对照组剖宫产率显著高于镇痛组(P＜0.01),第一产程末NE、E浓度显著高于镇痛组(P＜0.01).A组用药量、瘙痒发生率低及胎头吸引率均低于B组(P＜0.01).结论0.2%罗哌卡因复合芬太尼2μg/ml硬膜外自控镇痛安全有效,降低了剖宫产率,在相同的分娩镇痛水平PCEA-LP模式比PCEA-LCP模式用药更少,副作用发生率低.     

A Comparison of Epidural Morphine and Epidural Bupivacaine for Postoperative Pain Relief

In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6–8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4–6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. Thoracic administration of morphine also resulted in a significantly longer duration of pain relief (on average 9.8 h) than that of bupivacaine (3.8 h). Morphine gave satisfactory pain relief in all cases. It was not associated with motor block, loss of sensitivity to temperature, touch, or pin-prick, or any signs of sympathetic block, as was the case with epidural bupivacaine. Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.     

硬膜外阻滞用于分娩镇痛100例临床分析

目的 :探讨硬膜外阻滞用于分娩镇痛的镇痛效果及对产程的影响。方法 :选择 10 0例硬膜外镇痛分娩的初产妇作为观察组 ,将未采用任何分娩镇痛药物而进入产程的初产妇 10 0例作为对照组 ,分别观察产程、分娩方式、产后出血量和脐动脉血气。结果 :观察组镇痛后疼痛视觉模拟评分显著低于镇痛前 (P <0 0 1)。观察组脐动脉血 pH(7 32 8± 0 0 6 4)显著高于对照组 pH(7 2 6 3± 0 0 73) (P <0 0 1)。两组产程、分娩方式、产后出血量比较无显著性差异(P >0 0 5 )。结论 :硬膜外阻滞用于分娩镇痛安全有效 ,对母婴无不良影响。     

硬膜外连续泵注芬太尼与布比卡因用于分娩镇痛的临床研究

目的：探讨硬膜外泵注芬太尼与布比卡因用于分娩镇痛的有效性及安全药物剂量。方法：以０．１５％布比卡因为对照,比较０．０００５％至０．００１２％范围内四种不同浓度芬太尼与之混合硬膜外泵注的分娩镇痛效果。结果：选用０．０００８％与０．００１％两种浓度芬太尼与０．１５％布比卡因混合泵注时,镇痛作用起效快,镇痛时间明显延长,而且不增加副作用。结论：硬膜外连续泵注芬太尼与布比卡因用于分娩镇痛能明显改善镇痛效果,芬太尼使用浓度以限制在０．０００８％至０．００１％为宜。     

Bupivacaine Augments Intrathecal Fentanyl for Labor Analgesia

Background: Intrathecal fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low-dose bupivacaine added to intrathecal fentanyl for labor analgesia.

Methods: Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 [micro sign]g; bupivacaine, 1.25 mg, with fentanyl, 25 [micro sign]g; or bupivacaine, 2.5 mg, with fentanyl, 25 [micro sign]g, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded.

Results: Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 [micro sign]g, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged.     

布比卡因分别复合芬太尼、咪唑安定或曲马多用于术后硬膜外自控镇痛的比较

目的：比较布比卡因分别复合芬太尼,咪唑安定,曲马多行术后硬膜外自控镇痛（ＰＣＥＡ）的临床效果。方法：６０例在腰麻加硬膜外麻醉下行择期妇科手术的病人分为四组。Ａ组：０．１２５％布比卡因：Ｂ组：０．１２５％布比卡因＋芬太尼,Ｃ组０．１２５％布比卡因＋咪唑安定,Ｄ组：０．１２５％布比卡因＋曲马多ＰＣＥＡ参数设置,负荷剂量６ｍｌ,单次剂量３ｍｌ,锁定时间３０分钟,持续剂量２ｍｌ／ｈ。术后分别记录２４小时用     

Effect of Intravenous versus Epidural Fentanyl on the Minimum Local Analgesic Concentration of Epidural Bupivacaine in Labor

Background: The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the relative local anesthetic sparing efficacies of intravenous and epidural fentanyl by comparison of their effects on the MLAC of bupivacaine.

Methods: In this double-blind, randomized, prospective study, 84 parturients at <= 7-cm cervical dilation who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 44) or bupivacaine with 3 [mu]g/ml (60 [mu]g) fentanyl (n = 40) was administered. The plain bupivacaine group then received 60 [mu]g intravenous fentanyl. The bupivacaine-fentanyl group received intravenous saline. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with <= 10 mm within 30 min defined as effective.

Results: The MLAC of bupivacaine-intravenous fentanyl was 0.064% wt/vol (95% confidence interval, 0.049-0.080), and the MLAC of bupivacaine-epidural fentanyl was 0.034% wt/vol (95% confidence interval, 0.017-0.050). Epidural fentanyl significantly increased the analgesic potency of bupivacaine by a factor of 1.88 (95% confidence interval, 1.09-3.67) compared with intravenous fentanyl. The epidural fentanyl group demonstrated significantly higher dermatomal spread (P = 0.0064) and increased pruritus (P = 0.01).     

Effect of Epidural Epinephrine on the Minimum Local Analgesic Concentration of Epidural Bupivacaine in Labor

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 epinephrine by its effect on the MLAC of bupivacaine.

Methods: In this double-blind, randomized, prospective study, 70 parturients who were at 7 cm or less cervical dilation and who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 35) or bupivacaine with epinephrine 1:300,000 (n = 35) was administered. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with 10 mm or less within 30 min defined as effective.

Results: The MLAC of bupivacaine alone was 0.091% wt/vol (95% confidence interval, 0.081-0.102). The addition of epinephrine 1:300,000 (66.7 [mu]g) resulted in a significant reduction (P < 0.01) in the MLAC of bupivacaine to 0.065% wt/vol (95% confidence interval, 0.047-0.083). The lowest maternal blood pressure was significantly lower in the bupivacaine-epinephrine group (P = 0.03). There were statistically significant reductions in fetal heart rate (P = 0.011) in the bupivacaine-epinephrine group that were not clinically significant.