【原】【罌粟摘要】腰硬聯(lián)合麻醉與硬膜穿破硬膜外麻醉用于分娩鎮(zhèn)痛的比較：一項隨機對照試驗

罌粟花anesthGH 2024-12-31 發(fā)布于貴州

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腰硬聯(lián)合麻醉與硬膜穿破硬膜外麻醉用于分娩鎮(zhèn)痛的比較：一項隨機對照試驗

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：王貴龍編輯：王波審校：曹瑩

背景

硬膜穿破硬膜外麻醉（DPE）是腰硬聯(lián)合麻醉（CSE）的改良方法。目前比較這兩種方案的試驗資料有限。本研究旨在比較DPE和CSE技術(shù)用于分娩鎮(zhèn)痛的差異。

方法

將行分娩鎮(zhèn)痛的足月產(chǎn)婦被隨機分配為兩組：接受硬膜外破硬膜外麻醉（DPE組）與腰硬聯(lián)合麻醉（CSE組）；CSE組產(chǎn)婦腰麻使用2 mg布比卡因和10ug芬太尼開始鎮(zhèn)痛，DPE組產(chǎn)婦硬膜外使用20 ml 0.1%羅哌卡因和2ug/ml^-1芬太尼開始鎮(zhèn)痛，使用患者自控硬膜外鎮(zhèn)痛和程序化間歇硬膜外劑量維持鎮(zhèn)痛。該研究的主要指標是分娩鎮(zhèn)痛的質(zhì)量，由五個內(nèi)容構(gòu)成：麻醉開始30分鐘后的不對稱阻滯（感覺水平差異超兩個以上節(jié)段）；硬膜外加藥干預(yù)；導(dǎo)管調(diào)整；導(dǎo)管更換；剖宮產(chǎn)時轉(zhuǎn)換為椎管內(nèi)麻醉失敗，需要全身麻醉或重新行椎管內(nèi)麻醉阻滯。

結(jié)果

該研究共納入100名產(chǎn)婦（CSE組48名，DPE組52名）。兩組患者在主要指標鎮(zhèn)痛質(zhì)量方面沒有顯著差異（CSE組33%，DPE組25%，95% CI：0.75（0.40–1.39）；p=0.486）。CSE組患者在鎮(zhèn)痛開始15分鐘時的疼痛評分中位數(shù)（四分位數(shù)間距[范圍]）顯著低于DPE組：（0（0–1[0–8]）vs1（0–4[0–10]）；p=0.018）。

結(jié)論

硬膜穿破硬膜外麻醉與腰硬聯(lián)合麻醉對分娩鎮(zhèn)痛的質(zhì)量影響方面沒有顯著差異。

原始文獻來源：Hannah, Zang; Andrew, Padilla; Trung, Pham; Samantha M, Rubright; Matthew, Fuller; Amanda, Craig; Ashraf S, Habib；Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia a randomised controlled trial；Anaesthesia 2025 Jan;80(1):29-37；PMID：39511462；DOI10.1111/anae.16433

Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia a randomised controlled trial.

BACKGROUND: The dural puncture epidural technique is a modification of the combined spinal-epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal-epidural technique.

METHODS: Term parturients requesting labour epidural analgesia were allocated randomly to receive either dural puncture epidural or combined spinal-epidural. Analgesia was initiated with 2?mg intrathecal bupivacaine and 10ug fentanyl in parturients allocated to the combined spinal-epidural group and with 20?ml ropivacaine 0.1% with 2ug.ml^-1fentanyl in parturients allocated to the dural puncture epidural group. Analgesia was maintained using patient-controlled epidural analgesia with programmed intermittent epidural boluses. The primary outcome of the study was the quality of labour analgesia, which was defined by a composite of five components: asymmetric block after 30?min of initiation (difference in sensory level of more than two dermatomes); epidural top-up interventions; catheter adjustment; catheter replacement; and failed conversion to neuraxial anaesthesia for caesarean delivery, requiring general anaesthesia or replacement of the neuraxial block.

RESULTS: One hundred parturients were included in the analysis (48 combined spinal-epidural, 52 dural puncture epidural). There were no significant differences between the two groups in the primary composite outcome of quality of analgesia (33% in the combined spinal-epidural group vs. 25% in the dural puncture epidural group), risk ratio (95%CI) 0.75 (0.40-1.39); p?=?0.486. Median (IQR [range]) pain scores at 15?min were significantly lower in patients allocated to the combined spinal-epidural group compared with the dural puncture epidural group (0 (0-1[0-8]) vs. 1 (0-4 [0-10]); p?=?0.018).

CONCLUSIONS: There were no significant differences in the quality of labour analgesia following initiation of a combined spinal-epidural compared with a dural puncture epidural technique.

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