PDF(Pubmed)
Abstract：
This study aimed to compare the analgesic effects of programmed intermittent epidural boluses (PIEB) and continuous epidural infusion (CEI) for postoperative analgesia after elective cesarean section (CS).
Seventy-four women who underwent elective CS were randomized to receive either PIEB or CEI. The PIEB group received 4 ml-intermittent boluses of 0.11% ropivacaine every hour at a rate of 120 ml/h. The CEI group received a constant rate of 4 ml/h of 0.11% ropivacaine. The primary outcome was the pain score at rest at 36 h after CS. Secondary outcomes included the pain scores during mobilization, time-weighted pain scores, the incidence of motor blockade, and complications-related epidural analgesia during 36 h after CS.
The pain score at rest at 36 h after CS was significantly lower in the PIEB group compared with that in the CEI group (3.0 vs. 0.0; median difference: 2, 95% CI [1, 2], P < 0.001). The mean time-weighted pain scores at rest and during mobilizations were also significantly lower in the PIEB group than in the CEI group (pain at rest; mean difference [MD]: 37.5, 95% CI [24.6, 50.4], P < 0.001/pain during mobilization; MD: 56.6, 95% CI [39.8, 73.5], P < 0.001). The incidence of motor blockade was significantly reduced in the PIEB group compared with that in the CEI group (P < 0.001).
PIEB provides superior analgesia with less motor blockade than CEI in postpartum women after CS, without any apparent adverse events.
Seventy-four women who underwent elective CS were randomized to receive either PIEB or CEI. The PIEB group received 4 ml-intermittent boluses of 0.11% ropivacaine every hour at a rate of 120 ml/h. The CEI group received a constant rate of 4 ml/h of 0.11% ropivacaine. The primary outcome was the pain score at rest at 36 h after CS. Secondary outcomes included the pain scores during mobilization, time-weighted pain scores, the incidence of motor blockade, and complications-related epidural analgesia during 36 h after CS.
The pain score at rest at 36 h after CS was significantly lower in the PIEB group compared with that in the CEI group (3.0 vs. 0.0; median difference: 2, 95% CI [1, 2], P < 0.001). The mean time-weighted pain scores at rest and during mobilizations were also significantly lower in the PIEB group than in the CEI group (pain at rest; mean difference [MD]: 37.5, 95% CI [24.6, 50.4], P < 0.001/pain during mobilization; MD: 56.6, 95% CI [39.8, 73.5], P < 0.001). The incidence of motor blockade was significantly reduced in the PIEB group compared with that in the CEI group (P < 0.001).
PIEB provides superior analgesia with less motor blockade than CEI in postpartum women after CS, without any apparent adverse events.
摘要：
这项研究旨在比较选择性剖宫产（CS）后程序性间歇性硬膜外推注（PIEB）和连续硬膜外输注（CEI）的镇痛效果。
74名接受选择性CS的女性被随机分配接受PIEB或CEI。PIEB组以120ml/h的速率每小时接受4ml间歇性的0.11％罗哌卡因推注。CEI组接受恒定速率4ml/h的0.11%罗哌卡因。主要结果是CS后36小时休息时的疼痛评分。次要结果包括动员期间的疼痛评分，时间加权疼痛评分,运动阻滞的发生率，以及CS后36h内与硬膜外镇痛相关的并发症。
与CEI组相比，PIEB组CS后36h静息时的疼痛评分显着降低（3.0vs.0.0；中位数差异，2；95%CI：1，2；P<0.001）。PIEB组的静息和动员期间的平均时间加权疼痛评分也显着低于CEI组（静息疼痛：平均差异，37.5;95%CI,[24.6,50.4];P<0.001;活动期间疼痛:平均差异,56.6；95%CI，[39.8，73.5]；P<0.001）。与CEI组相比,PIEB组的运动阻滞发生率明显降低(P<0.001)。
在CS后的产后妇女中，PIEB比CEI提供了更好的镇痛效果，运动阻滞更少，没有任何明显的不良事件。
74名接受选择性CS的女性被随机分配接受PIEB或CEI。PIEB组以120ml/h的速率每小时接受4ml间歇性的0.11％罗哌卡因推注。CEI组接受恒定速率4ml/h的0.11%罗哌卡因。主要结果是CS后36小时休息时的疼痛评分。次要结果包括动员期间的疼痛评分，时间加权疼痛评分,运动阻滞的发生率，以及CS后36h内与硬膜外镇痛相关的并发症。
与CEI组相比，PIEB组CS后36h静息时的疼痛评分显着降低（3.0vs.0.0；中位数差异，2；95%CI：1，2；P<0.001）。PIEB组的静息和动员期间的平均时间加权疼痛评分也显着低于CEI组（静息疼痛：平均差异，37.5;95%CI,[24.6,50.4];P<0.001;活动期间疼痛:平均差异,56.6；95%CI，[39.8，73.5]；P<0.001）。与CEI组相比,PIEB组的运动阻滞发生率明显降低(P<0.001)。
在CS后的产后妇女中，PIEB比CEI提供了更好的镇痛效果，运动阻滞更少，没有任何明显的不良事件。
