PDF(Pubmed)
Abstract：
Objective The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either by bolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs. Methods A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns. Results All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed by the obstetrician. Conclusion Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.
摘要：
目的分娩过程中疼痛管理的金标准是硬膜外镇痛,可以通过两种不同的方式给产妇服用，通过推注剂量或连续输注阿片类药物的局部麻醉溶液。最近,通过泵编程的间歇性硬膜外推注（PIEB）作为一种非常有效的方法，副作用最小。这项研究的目的是评估两种不同方案（芬太尼2μg/ml均为0.1％或0.2％）之间的最佳罗哌卡因浓度，该方案可以在最低程度的运动阻滞下提供令人满意的镇痛效果。使用PIEB。方法2020年3月至2022年3月进行前瞻性随机对照研究。通过PIEB将两种不同浓度的0.1％和0.2％的罗哌卡因平均分配给两组产妇，并在需要时进行额外的患者对照硬膜外抢救推注。我们的主要终点是运动阻滞，通过改良的Bromage量表（MBS）评估。我们还记录了视觉模拟量表(VAS)得分，心率,血压,局部麻醉药总消耗量，劳动期限和交货方法，和新生儿的APGAR评分。结果所有患者的Bromage评分均等于6分，两组之间的麻醉溶液总消耗量具有可比性。与0.1%组相比，0.2%组的女性表现出更高的疼痛缓解和满意度。关于0,2%的组,舒张压和APGAR评分较低,同时产科医生观察到较低的满意挤压期。结论两种罗哌卡因方案均可为孕妇提供满意的硬膜外分娩镇痛，而无需任何运动阻滞。
