目的:比较不同腰穿水平硬膜外镇痛产妇实现无痛子宫收缩的速度。
方法:本研究是在四川省某三级甲等医院进行的一项随机对照试验,有80多年的历史,中国。招募22-40岁的产妇,计划在硬膜外镇痛下进行阴道分娩。符合条件的患者被随机分为腰椎2-3(L2-3)或腰椎3-4(L3-4)组。根据分组,通过间隙进行硬膜外镇痛。主要结果是镇痛开始后15分钟无痛子宫收缩的百分比。次要结局包括5分钟和10分钟时无痛状态的百分比,感觉块平面,电机块评估,产妇的不良事件,硬膜外镇痛消耗,阿普加得分,和产妇镇痛的评估。
结果:在2023年4月至2023年8月之间,最终招募了150名女性,分析了其中136例(每组68例)。与L3-4组相比,在L2-3组镇痛开始后5、10和15分钟,无痛子宫收缩的比例明显更高(20.6%vs.7.4%,52.9%vs.26.5%,和80.9%vs.64.7%,P分别为.026、.002和.034)。同样,L2-3组在5、10和15分钟的疼痛评分低于L3-4组(5(4,7)vs.6(5,7),3(2,5)vs.4(3,6),和2(1,3)vs.3(2,5),P分别=.006、.004和.020)。此外,通过L2-3间隙穿刺有助于提高产妇对镇痛程序的评价(9(8,9)与8(8,9),P<.001)。然而,感觉阻滞没有显著差异,电机块,或两组之间的不良事件。
结论:通过L2-3间隙穿刺与更快的疼痛缓解和更好的产妇体验相关。这些发现为麻醉医师进行硬膜外分娩镇痛提供了优越的选择。硬膜外镇痛是缓解分娩疼痛的有效方法。这项研究补充了什么?通过腰椎2-3间隙穿刺可引起硬膜外镇痛的更快发作。这项研究如何影响研究,实践或政策?在进行硬膜外分娩镇痛时,腰椎2-3间隙在缓解疼痛的速度和产妇的满意度方面是一个较好的选择。
OBJECTIVE: To compare the speed of achieving painless uterine contractions in parturients undergoing epidural analgesia at different lumbar puncture levels.
METHODS: This study is a randomized controlled trial at a tertiary A hospital with a history of over 80 years in Sichuan Province, China. Parturients aged 22-40 years old scheduled for vaginal delivery under epidural analgesia were recruited. Eligible patients were randomly allocated into lumbar 2-3 (L2-3) or lumbar 3-4 (L3-4) groups. Epidural analgesia was performed through the interspaces according to grouping. The primary outcome was the percentage of painless uterine contractions 15 min after the initiation of analgesia. The secondary outcomes included the percentage of painless status at 5 and 10 min, sensory block plane, motor block evaluation, adverse events of parturients, epidural analgesic consumption, Apgar score, and the parturients\' evaluation of analgesia.
RESULTS: Between April 2023 and August 2023, a total of 150 women were finally recruited, and 136 of them were analyzed (68 in each group). In comparison with the L3-4 groups, there was a significantly larger proportion of painless uterine contractions at 5, 10, and 15 min after analgesia initiation in the L2-3 group (20.6% vs. 7.4%, 52.9% vs. 26.5%, and 80.9% vs. 64.7%, P = .026, .002, and .034, respectively). Similarly, the pain scores were lower in the L2-3 group at 5, 10, and 15 min than that in the L3-4 group (5(4,7) vs. 6(5,7), 3(2,5) vs. 4(3,6), and 2(1,3) vs. 3(2,5), P = .006, .004, and .020, respectively). Furthermore, puncturing through the L2-3 interspace contributed to a higher evaluation of parturients to the analgesia procedure (9(8,9) vs. 8(8,9), P < .001). However, there was no significant difference in sensory block, motor block, or adverse events between the two groups.
CONCLUSIONS: Puncturing through the L2-3 interspace is associated with faster pain relief and a better experience for parturients. These findings present a superior option for anesthesiologists when conducting epidural labor analgesia. Key messages What is already known on this topic? Epidural analgesia is an effective way to relieve labor pain. What this study adds? Puncturing via lumbar 2-3 interspace induces more rapid onset of epidural analgesia. How this study might affect research, practice or policy? Lumbar 2-3 interspace is a superior option in terms of the speed of pain relief and satisfaction of parturients when conducting epidural labor analgesia.