背景:本研究的目的是评估静脉注射帕洛诺司琼与昂丹司琼相比对剖宫产产妇腰麻引起的低血压的影响。
方法:54例择期剖宫产的妇女,随机分为昂丹司琼组(n=27)或帕洛诺司琼组(n=27)。脊髓麻醉给药前十分钟,参与者接受了昂丹司琼或帕洛诺司琼的静脉注射.鞘内施用布比卡因和芬太尼后立即开始预防性去氧肾上腺素输注。滴定输注速率以维持足够的血压直至胎儿分娩时。主要结果是给予去氧肾上腺素的总剂量。次要结果是恶心或呕吐,解救止吐药的需要,低血压,心动过缓,颤抖着。完全应答率,定义为没有术后恶心和呕吐,不需要额外的止吐药,在手术后24小时内进行评估。
结果:在昂丹司琼和帕洛诺司琼组之间使用的去氧肾上腺素的总剂量(387.5μg[四分位距,291.3-507.8μg与428.0μg[四分位数间距,305.0-507.0μg],P=0.42)。脊髓麻醉后两小时内(昂丹司琼组88.9%,帕洛诺司琼组100%;P=0.24)和术后24小时内(昂丹司琼组81.5%,帕洛诺司琼组88.8%;P=0.7)两组完全缓解率也无显着差异。此外,其他次要结局无差异.
结论:预防性使用帕洛诺司琼在缓解行布比卡因和芬太尼用于剖宫产的腰麻患者的血流动力学变化或减少对苯肾上腺素的需求方面,没有表现出比昂丹司琼更好的效果。
BACKGROUND: The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section.
METHODS: Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic
phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of
phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery.
RESULTS: No significant differences were observed in the total dose of
phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3-507.8 μg versus 428.0 μg [interquartile range, 305.0-507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes.
CONCLUSIONS: Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing
phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.