Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Advances in epidural labor analgesia:Effectiveness and treatment strategies of butorphanol

In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.

Effects of Ropivacaine-sufentanil Epidural Analgesia on Labor and Maternal and Neonatal Outcomes

[Objectives]This study aimed to investigate the effects of ropivacaine-sufentanil epidural analgesia on labor and maternal and neonatal outcomes.[Methods]A total of 180 primiparas in full-term pregnancy were selected.They were randomly divided into treatment group(n=90)and control group(n=90).The primiparas in the treatment group were injected epidurally with ropivacaine and sufentanil for analgesia,and the primiparas in the control group were subjected to vaginal delivery.The VAS scores at 5,10,30 and 60 min of analgesia were observed.The vaginal bleeding amount,total labor duration,neonatal Apgar score and vaginal delivery rate of the two groups were compared.[Results]Compared with the control group,the VAS score in the treatment group differed insignificantly after 5 min of analgesia(P>0.05),and decreased significantly after 10,30 and 60 min of analgesia(P<0.05).The vaginal bleeding amount of the treatment group was significantly smaller than that of the control group(P<0.05).There was no significant difference in the neonatal Apgar score between the two groups(P>0.05).In the treatment group,the vaginal delivery rate increased(P<0.05),the second stage of labor was prolonged(P<0.05),and the first and third stages of labor did not change significantly(P>0.05).[Conclusions]Epidural analgesia with ropivacaine and sufentanil has a good analgesic effect and good safety,and is worthy of clinical promotion.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

BACKGROUND For parturients with paroxysmal uterine contraction pain,rapid analgesia is needed.We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor,and evaluated the usefulness of this technique in epidural labor analgesia.AIM To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODS In this prospective randomized observational study,72 parturients were assigned to two groups(combined or palpation group).The target interspace of all parturients was first identified by the palpation technique.Then in the combined group,preprocedure ultrasound imaging was used before epidural puncture.In the palpation group,only the traditional anatomical landmarks technique(palpation technique)was performed.The primary outcome was total duration of the epidural procedure(for the ultrasound group,the duration of the preprocedure ultrasound imaging was included).The secondary outcomes were the number of skin punctures,the success rate at first needle pass,the number of needle passes,the depth from the skin to epidural space,and the complications of the procedure.RESULTS Total duration of the epidural procedure was similar between the two groups(406.5±92.15 s in the combined group and 380.03±128.2 s in the palpation group;P=0.318).A significant improvement was demonstrated for epidural puncture and catheterization in the combined group.The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group(P=0.001).The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group(P=0.398).The success rate at first needle pass was 88.89%in the combined group and 66.67%in the palpation group(P=0.045).CONCLUSION This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique,which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar’s score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar’s score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.

Evaluation of the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia

Objective: To study the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia. Methods: Primiparae who received vaginal delivery under epidural analgesia in Ankang People's Hospital between March 2015 and February 2017 were selected and randomly divided into accepting the group A who received ropivacaine combined with sufentanil for epidural analgesia and the group B who received ropivacaine alone for epidural analgesia. During the first, the second and the third stage of labor, the serum was collected to determine the levels of pain mediators SP, 5-HT and PGE2 as well as stress hormones NE, E, F-C, AT-II and INS;after delivery, the placenta tissue was collected to determine the expression of stress molecules GRP78, CHOP, Nrf-2 and ARE. Results: Serum SP, 5-HT, PGE2, NE, E, F-C, AT-II and INS levels of group A during the first, the second and the third stage of labor were significantly lower than those of group B;GRP78, CHOP, Nrf-2 and ARE mRNA expression in placental tissue of group A after delivery were significantly lower than those of group B. Conclusion: ropivacaine combined with sufentanil for epidural labor analgesia is more effective than ropivacaine alone in reducing pain and inhibiting stress response.

A systematic Review of the Safety and Effectiveness of Epidural Analgesia for Labor Analgesia

Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.

An <i>in Vitro</i>Evaluation of Pressure Generated by Programmed Intermittent Epidural Bolus (PIEB) or Continuous Epidural Infusion (CEI)

PIEB has been reported as being superior to CEI for labor analgesia. The aim of this study was to measure the pressures generated by two commercially available pumps (CADD PIB, Smiths and Gemstar, Hospira) when delivering PIEB or CEI at 2 commonly used rates of infusion (10 or 5 mL). The two pumps were set to deliver fluid at four rates (CEI: 5 or 10 mL/h;PIEB: 5 or 10 mL every h) and connected to a pressure transducer (PCB Piezotronics 1500 connected to a NI USB-6251 Screw Terminal) to determine the pressures applied during each infusion. The peak pressure generated during the PIEB mode was consistently higher when compared to the CEI mode in both pumps. When comparing the two pumps in the PIEB 10 mL every hour mode, the peak pressures were approximately the same, while the pressure pattern differed. For each cycle the pressure generated by Gemstar oscillated from 25 mmHg to 0 mmHg;whereas with the CADD pump the baseline pressure was above 0. The Gemstar pump piston frequency (1.2 Hz) was twice as high as the CADD (0.5 Hz), so the volume delivered per cycle was lower. In the PIEB 5 mL every hour mode the peak pressures followed the same wave patterns. However, unlike the 10 mL mode, the pump piston frequency was approximately the same in both pumps. In both the CEI 5 or 10 mL/h modes, the CADD peak pressure was four times greater than the Gemstar. Both cycled between their respective peak pressures and 0 mmHg. Since the peak pressure of the CADD was approximately the same with PIEB and CEI, we speculated that the most important factor affecting the distribution of the solution in the epidural space was not the peak pressure per se, but the mode of delivery of the bolus.

Women’s Awareness and Attitudes towards Labor Analgesia Influencing Practice between Developed and Developing Countries

Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more women become aware of their rights to achieve a better quality of care during labor. There are various non-pharmacologic (transcutaneous electrical nerve stimulation, hydrotherapy, intradermal water injections and acupuncture) and pharmacologic treatments (nitrous oxide, opioids and regional analgesia techniques: spinal, epidural and combined epidural analgesia) available today. Among these, epidural analgesia offers the most effective form of pain relief and is considered to be the gold standard of labor analgesia. Despite having labor analgesic services, most women still go through painful labor due to lack of knowledge regarding it, particularly in developing countries. The main source of information regarding pain reliefs is from friends and relatives, revealing the lack of information from caregiver’s side. So this study reflects that there is a wide gap in the communication between pregnant women and obstetricians. It supports the fact that obstetricians through the practice of routinely offering labor analgesia can significantly improve the maternal and perinatal outcomes of pregnancy. Provision of standardized epidural analgesia information at an appropriate time in their pregnancy may benefit them by the practice of mutual decision-making. Thus, it may prevent women from making a difficult choice of cesarean section to avoid the fear of painful labor.

Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor： a randomized clinical trial

Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine （Group B）, ropivacaine （Group R） or levobupivacaine （Group L） with sufentanil 0.5 ug/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was 〈30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction （P 〉0.05）. The relative median potency was bupivacaine/ropivacaine： 0.828 （0.602-1.091）, bupivacaine/levobupivacaine： 0.845 （0.617-1.12）, ropivacaine/levobupivacaine： 1.021 （0.774-1.354）, respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of 〉0.1% within each group （P 〈0.05）. Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with s＇ufentanil produce similar analgesia and motor block and safety for labor analgesia. The analgesic efficacy mainly depends on the concentration rather than the type of anesthetics.

Concerned topics of epidural labor analgesia:labor elongation and maternal pyrexia:a systematic review

Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.

Effect of epidural analgesia with 0.075% ropivacaine versus 0.1% ropivacaine on the maternal temperature during labor： a randomized controlled study

Background A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1% ropivacaine on the maternal temperature during labor. Methods Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 IJg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes. Results Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes. Conclusion Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

Potential impact of epidural labor analgesia on the outcomes of neonates and children

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia(ELA)on the outcomes of neonates and children.Terms and relevant words including“ELA,”“ELA and neonatal outcomes,”“ELA and children’s development,”and“ELA and children’s neurocognitive development”were used to search articles published in PubMed database up to October 2019.Original articles and reviews regarding potential influences of ELA on neonates and children were identified.Relevant references of the selected articles were also screened.The anesthetics used during ELA can be absorbed,enter the fetus,and produce neonatal depression;however,these effects are less severe than those during systematic opioid analgesia.The impact of anesthetic exposure during ELA on children’s neurodevelopment has not been fully studied,but would be mild if any.ELA increases the risk of intrapartum maternal fever;the latter may be harmful to neonatal outcomes.The use of ELA may increase birth injury by increasing instrumental delivery,although long-term adverse events are rare.On the other hand,ELA may reduce maternal depression and,thus,produce favorable effects on neurocognitive development in childhood;but evidences are still lacking in this aspect.ELA may produce both favorable and unfavorable effects on neonates and children.These effects should be discussed with parturient women before making decisions.The potential harmful effects should be carefully managed.The overall impacts of ELA on neonatal and children’s outcomes need to be studied further.

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.

硬膜外分娩镇痛产妇产间发热风险预测模型的构建与验证

目的:构建硬膜外分娩镇痛产妇产间发热(ERMF)风险预测模型并验证效果。方法:采用前瞻性研究方法,选取2022年1月—2022年7月于江苏省某三级甲等妇产医院产房接受硬膜外分娩镇痛的780名产妇为研究对象,根据是否诊断为ERMF分为ERMF组(n=148)与非ERMF组(n=632)。使用Logistic回归分析确定ERMF的独立危险因素,构建风险预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线与Hosmer-Lemeshow检验评价该模型的预测效能与拟合优度。选取2022年8月—10月住院的170名产妇作为模型的验证组,对预测模型进行验证。结果:建模组ERMF发生率为19.0%,验证组ERMF发生率20.6%。阴道指检次数、缩宫素使用、产程、胎膜破裂至分娩结束时间、罗哌卡因用量、舒芬太尼用量是ERMF的独立危险因素。预测模型的ROC曲线下面积为0.987,灵敏度为0.912,特异度为0.796,约登指数为0.888。验证组ROC曲线下面积为0.893,灵敏度为0.886,特异度为0.785。结论:该预测模型具有较好的区分度和校准度,对于识别高危ERMF产妇具有一定的预测价值,可以给临床护理工作提供一定的借鉴与参考,从而制定相应的护理措施以减少ERMF风险。

Urgent Need of Continuing Medical Education:The Key for Patient Awareness of Labor Epidural Analgesia-A Survey of Chinese Perinatal Care Providers

Objective:This survey was designed to understand the misconceptions about labor epidurals.Methods:This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st,2015 to January 1st,2016 via mainly WeChat groups dedicated to perinatal healthcare providers in China.The questionnaire included items inquiring the knowledge and opinions about labor epidural analgesia related to maternal complications,baby safety,and effect on laboring.Incomplete surveys were excluded from the data analysis.The data was presented as percentages and a Chi-square test or Fisher's exact test,as appreciate,was used to quantitatively compare the results.Results:A total of 1412 respondents completed surveys with 42.9%(606/1412)of them being anesthesiologists,35.1%(495/1412)being obstetricians,11.8%(167/1412)being midwives,3.7%(52/1412)being labor and delivery nurses,and 6.5%(92/1412)being hospital administrators and unspecified.The study revealed a lack of knowledge in labor pain control.Although 82.4%(1164/1412)of respondents were familiar with labor epidural analgesia,8.9%(126/1412)did not know how it works,and 1.1%(15/1412)never heard it in a multiple-choice question.The three main groups(anesthesiologists,obstetricians,and midwives/labor and delivery nurses)were chosen for comparisons.Opinions among these three groups concerning five questions in the three main concerns were evaluated using a statistical significance of P<0.05.Conclusion:The results in our survey indicated an urgent need of continuing medical education to multidisciplinary specialties to improve evidence-based medical practices as these misconceptions have existed for over 10 years in the medical professionals.Lack of public awareness fueled by misconceptions related to labor epidural analgesia may be associated with a lack of professional knowledge.Correct knowledge in professionals needs to be disseminated to the public in order to dispel possible misconceptions and rumors about labor epidural analgesia.This would not only enhance patient understanding of their care but also improve maternal,fetal,and neonatal outcomes.

硬膜外分娩镇痛对产妇产后抑郁的影响

目的评估硬膜外分娩镇痛(LEA)对产妇产后抑郁(PPD)的影响。方法选择经阴道分娩的初产妇628例,年龄20~36岁,BMI 20~35 kg/m 2,ASAⅡ或Ⅲ级。根据产妇是否接受硬膜外分娩镇痛分为两组:镇痛组(n=322)和非镇痛组(n=306)。记录分娩期间VAS疼痛评分最高值、产程时间、出血量、新生儿1、5 min Apgar评分和新生儿入NICU的发生情况。于分娩前1周和产后2周、6周分别采用爱丁堡产后抑郁量表(EPDS)评估PPD发生情况(EPDS评分≥11分为PPD),采用广泛性焦虑量表(GAD-7)评估产妇焦虑情绪,采用领悟社会支持量表(PSSS)评估产妇感受到的总社会支持度。结果与非镇痛组比较,镇痛组产妇分娩期间VAS疼痛评分最高值明显降低(P<0.05)。两组产妇第一产程时间、第二产程时间、出血量、新生儿1、5 min Apgar评分、新生儿入NICU比例差异无统计学意义。两组产妇产后2、6周PPD发生率、PSSS高支持状态、GAD-7≥10分差异无统计学意义。结论初产妇接受LEA不影响产后抑郁的发生风险。

0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因EC_(50)的影响

目的探讨0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因半数有效浓度(EC_(50))的影响。方法选择2023年7月至10月在我院行阴道分娩且有镇痛需求的产妇67例,按随机数字表法分为RL组(33例)和R组(34例)。采用Dixon改良序贯法确定罗哌卡因的浓度。RL组产妇给予0.2%盐酸氯普鲁卡因注射液+盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液;R组产妇给予盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液。观察两组产妇的罗哌卡因EC_(50)、分娩镇痛效果、镇痛药总用量、镇痛满意度评分、不良反应发生情况、分娩情况及新生儿Apgar评分。结果RL组产妇的罗哌卡因EC_(50)、镇痛起效时间、补救镇痛率、会阴胀痛和爆发痛发生率、镇痛药总用量均显著低于R组,镇痛满意度评分显著高于R组(P<0.05);两组产妇的下肢麻木、下肢无力、寒战等不良反应发生率,产程时间、出血量、分娩方式及新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。结论0.2%氯普鲁卡因联合罗哌卡因用于硬膜外分娩镇痛,可降低罗哌卡因的EC_(50),改善分娩镇痛效果,且安全性较好。

硬膜外分娩镇痛相关发热对产妇分娩方式和助产方式的影响

目的研究硬膜外分娩镇痛引起的发热对产科分娩方式和助产方式的影响。方法对2020年1-6月于济宁医学院附属医院接受硬膜外分娩镇痛的孕妇病例进行回顾性队列研究。孕妇行硬膜外分娩镇痛后,根据有无发热将其分为发热组和非发热组。研究主要结局是硬膜外分娩镇痛相关发热对产科分娩方式,助产方式的影响,次要结局是抗生素使用情况以及新生儿因呼吸窘迫综合征或脓毒症收入重症医学病房(intensive care unit,ICU)的发生情况。结果本研究开始纳入856例孕妇,最终574例孕妇符合标准并对其临床资料进行了分析,其中硬膜外分娩镇痛相关发热128例(发热组),未发热446例(未发热组)。发热组剖宫产发生率为16.4%,未发热组剖宫产发生率7.3%,二者差异具有统计学意义(P<0.05)。抗生素使用情况在发热组12.5%,未发热组2.2%,差异具有统计学意义(P<0.001)。两组经阴分娩产妇之间助产、侧切以及新生儿因呼吸窘迫综合征或脓毒血症入ICU差异没有统计学意义(P>0.05)。结论硬膜外分娩镇痛引起的非感染性发热会增加产妇剖宫产发生率以及孕妇围产期抗生素使用率,但对于经阴助产需求以及新生儿因呼吸窘迫综合征或脓毒血症入ICU情况影响差异无统计学意义。

经皮穴位电刺激联合连续性硬膜外麻醉在初产妇分娩镇痛中的效果

目的探讨经皮穴位电刺激联合连续性硬膜外麻醉在初产妇分娩镇痛中的效果及其对分娩结局的影响。方法将160例初产妇按随机数表法分为E组、T组、E+T组及C组,每组40例。E组采用连续性硬膜外麻醉分娩镇痛,T组采用经皮穴位电刺激分娩镇痛,E+T组采用经皮穴位电刺激联合连续性硬膜外麻醉分娩镇痛,C组不进行分娩镇痛。比较4组分娩方式,产程,产后出血发生率,镇痛前及宫口开2、4、6 cm和宫口全开时视觉模拟量表(VAS)疼痛评分,新生儿出生1、5、10 min后的Apgar评分,镇痛前、宫口开4 cm和宫口开全时血清β-内啡肽水平;比较E+T组与E组的镇痛药物用量。结果E+T组自然分娩率显著高于E组、T组及C组,第一及第二产程显著短于E组、T组及C组,差异均有统计学意义(P<0.05)。4组产后出血发生率比较差异无统计学意义(P>0.05)。镇痛前4组VAS评分及血清β-内啡肽水平差异均无统计学意义(P>0.05);宫口开2、4、6cm和宫口全开时E+T组VAS评分显著低于E组、T组及C组,E组及T组显著低于C组,E组显著低于T组,宫口开4cm和宫口开全时E+T组血清β-内啡肽水平显著高于E组、T组及C组,T组显著高于E组及C组,差异均有统计学意义(P<0.05)。4组新生儿出生1、5、10 min后Apgar评分比较差异均无统计学意义(P>0.05)。E+T组镇痛药物用量显著少于E组,差异有统计学意义(P<0.05)。结论经皮穴位电刺激联合连续性硬膜外麻醉在初产妇分娩镇痛中的作用相对更好,且可有效改善分娩结局。