不同浓度罗哌卡因联合芬太尼在镇痛分娩中的应用

Effect of 0.06% and 0.12% ropivacaine with 2μg/ml fentanyl on analgesic natural labor

目的 对不同浓度罗哌卡因联合芬太尼镇痛分娩的效果进行观察。方法 以患者控制硬膜外腔给药方式(PCEA),将0.06％及0.12％的罗哌卡因联合芬太尼对40例健康的初产妇进行硬膜外腔麻醉镇痛处理。同时选择相同条件且未予任何镇痛处理的孕妇100例为对照组。观察产妇对疼痛的评分、运动神经阻滞程度、各产程时间及产程中用药情况、产妇的并发症及新生儿Apgar评分。结果 研究组孕产妇对分娩镇痛评分没有显著差异,新生儿Apgar评分与运动神经阻滞程度相似。而镇痛组的第2产程均较未镇痛组长约25min,高浓度罗哌卡因组出现更多的产后出血及尿潴留。结论 以PCEA方式给予2种浓度的罗哌卡因联合芬太尼能产生良好的镇痛效果,但后者可能更易于抑制子宫收缩,以至产后出血与尿潴留发生率增加。

Objective To compare the outcomes of 0.06% and 0.12% ropivacaine combined with 2μg/ml fentanyl by patient-controlled epidural analgesia(PCEA) in normal labor. Methods Forty healthy primiparous women bearing a single full - term fetus with vertex presentation were randomized to receive either 0.06% or 0.12% ropivacaine and 2 μg/ml fentanyl via a patient-controlled epidural analgesia pump(5-ml bolus dose, 10-min locked-out period, basal infusion 5 ml/h) . 100 normal parturient women with the same conditions without analgesic treatment were enrolled as controls. Pain score on a number review scale(NRS) , level of motor block,patient-controlled epidural analgesia ratio, drug use, supplemental boluses, and side effects were recorded at 30 min and then hourly. Mode of delivery, duration of first and second stages of labor, Apgar scores of the newborn , and retention of urine after delivery were also rewoded. Results No differences were seen between the two groups for pain scores on NRS during labor , mode of delivery, and motor block during the first stage of labor. Each of the neonates in both groups have Apgar scores > 7. A higher total dose of 0.12% ropivacaine was used, but without significant difference( P > 0.05) .Postoartum hemorrhage was significant in 0. 12% ropivacane group. Duration of the second stage of labor was similar in the study groups[(1.3±1.0) vs(1.4±1.2) h; P >0.05] , but longer than the controll group[(0.9±0.6) h, P <0.05]. Retention of urine after delivery was noticed in the higher concentration group but none in the lower concentration group one. Conclusions 0.06% or 0.12% ropivacaine combined with 2μg/ml fentanyl via PCEA can effectively relieve labor pain,but higher concentration of ropivacaine may likely inhibit the uterine contraction and increase the turition, post partum heamorrhage.