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.

Butorphanol in epidural:Could this be the breakthrough solution for safe and effective labor analgesia that we've been waiting for?

The authors have conducted a comprehensive investigation into the safety and effectiveness of butorphanol for epidural analgesia during labor.Their critical analysis of the paper and discussion of the technique's advantages and disadvantages provide a thorough understanding of the topic.

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 combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

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.

Comparison between 0.06% and 0.1% Levobupivacaine Combined with 2 μg/mL of Fentanyl for Epidural Labor Analgesia

Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia has not been adequately studied. The objective of this retrospective study was to compare the analgesic effect of levobupivacaine between 0.06% and 0.1% both combined with 2 μg/mL of fentanyl. Methods: Primiparous women (ASA I, II) who delivered their babies to our hospital using combined spinal epidural analgesia and patient-controlled epidural analgesia between August 1, 2011 and September 30, 2011 were included into this retrospective study. The analgesic solution for epidural administration was 0.06% levobupivacaine with 2 μg/mL of fentanyl between August 1 and 31, and 0.1% levobupivacaine with 2 μg/mL of fentanyl between September 1 and 30. Their anesthetic and obstetric charts were reviewed to compare obstetric outcome, anesthetic intervention, and patients’ satisfaction. Results: There were 46 women fulfilling the inclusion criteria: 23 women in 0.06% group, and 23 women in 0.1% group. The number of patients who needed more than 3 requests for one actual bolus was significantly higher in the 0.06% group (P 0.05). Conclusion: Our results revealed that 0.06% levobupivacaine combined with 2 μg/mL fentanyl does not provide sufficient analgesic effects for epidural labor analgesia. It seems that levobupivacaine has not been adequately studied after its withdrawal from the US market. Further studies should be conducted to determine the optimal concentration of levobupivacaine for epidural labor analgesia.

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.

Efficacy and safety of different doses of ropivacaine + sufentanil for epidural labor analgesia

Objective:To study the efficacy and safety of different doses of ropivacaine and sufentanil for epidural labor analgesia.Methods: The primiparae with single birth and cephalic presentation who underwent vaginal delivery in Chengde Maternal and Child Health Hospital between March 2015 and February 2018 were selected and randomly divided into the group A who received subarachnoid injection of sufentanil 4 μg, the group B who received injection of sufentanil 4 μg + ropivacaine 2 mg and the group C who received injection of sufentanil 4 μg+ ropivacaine 3 mg. During childbirth, serum was collected at the first, second and third stages of labor respectively to detect the secretion of pain mediators and oxidative stress mediators;after childbirth, the placenta was collected to determine the expression of stress molecules. Results: At first, second and third stages of labor, serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group B and group C were significantly lower than those of group A whereas SOD and GSH-Px secretion were significantly higher than those of group A, and serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group C were significantly lower than those of group B whereas SOD and GSH-Px secretion were significantly higher than those of group B;after childbirth, GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group B and group C were significantly lower than those of group A whereas Bcl-2 mRNA expression were significantly higher than that of group A, and GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group C were significantly lower than those of group B whereas Bcl-2 mRNA expression was significantly higher than that of group B.Conclusion: The analgesic effect of sufentanil 4 μg + ropivacaine 3 mg for epidural labor analgesia is the most significant.

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.

Effects of Different Modes of Labor Analgesia on Neonatal Neurobehavior

The term “painless delivery” originated from foreign countries and has a history of more than 100 years. It is actually called “childbirth analgesia” in medicine. Labor analgesia, as its name implies, is the use of various methods to reduce or even eliminate the pain during labor. With the development of anesthesiology and pain, it has been widely used in foreign countries, especially in some developed countries in the West. The rate of labor analgesia in the United States is > 85%, and even as high as 90% in Britain. The best childbirth analgesia should include side effect is small to puerpera and fetus, exact analgesic effect, quick effect, maintain time is long, can satisfy normal labor course;puerpera is awake, can cooperate childbirth and do not affect uterine contraction, and do not affect labor course progress. In 2000, WHO proposed that medical institutions should provide various labor analgesic services for parturient women to reduce labor pain as much as possible. Encourage the use of non-pharmaceutical analgesic techniques. In this paper, the effects of different modes of labor analgesia on neonates are described as follows.

Efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia

Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.

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.

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.

Effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion

Objective: To discuss the effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion. Methods: A total of 218 cases of puerperae who received caesarean section in the hospital between January 2015 and January 2017 were divided into control group (n=109) and observation group (n=109) by random table method. Control group received postpartum ropivacaine epidural analgesia alone, and observation group received postpartum ropivacaine combined with sufentanil epidural analgesia. The differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were compared between the two groups immediately after childbirth (T0), 6 h after delivery (T1), 12 h after delivery (T2) and 24 h after delivery (T3). Results: At T0, the differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were not statistically significant between the two groups. At T1, T2 and T3, serum NPY, β-EP and SP levels of observation group were lower than those of control group at corresponding points in time;serum IL-1β, hs-CRP and IL-6 levels of observation group were lower than those of control group at corresponding points in time;serum Cor, AngⅠ, AngⅡ and NE levels of observation group were lower than those of control group at corresponding points in time. Conclusion:Ropivacaine combined with sufentanil epidural analgesia after caesarean section can effectively inhibit the pain neurotransmitter expression and relieve the systemic inflammatory stress response in puerperae.

河北省医疗机构麻醉专业发展现状调查

目的了解河北省各医疗机构麻醉科发展现状,为促进麻醉专业发展提供基础数据依据。方法由河北省临床麻醉质量管理与控制中心通过“问卷星”网络平台发放电子问卷,对2020年河北省内所有二级以上医疗机构的麻醉科现状进行横断面普查,包括麻醉科人力资源结构、科室建设、麻醉医生工作负荷、分娩镇痛面临问题等项目,收集并分析相关数据。结果593家医疗机构完成问卷调查。河北省共有麻醉医生4839人(每万人口0.65人),三级医院较二级医院麻醉医生学历和职称明显更高,省内各市之间麻醉人力资源差距较大。河北省只有10%的医院实现了手麻系统信息化,麻醉门诊、麻醉恢复室(PACU)的设置率分别为20%和35%。73%的医院麻醉医生平均每日工作时长>8 h。将分娩镇痛纳入医保收费项目是河北省分娩镇痛面临的首要问题。结论河北省麻醉专业人力资源整体严重短缺,麻醉医生工作负荷较重,麻醉科室建设不足,且各地区之间、不同类别医院之间发展不均衡。

分娩镇痛:舒适与安全并行,教学与质控并举

分娩镇痛是以遵循产妇自愿和临床安全为原则,通过实施有效的分娩镇痛技术,以最大程度减轻产妇产痛的医疗服务。2018年,北京协和医院成为我国分娩镇痛首批试点单位,近年来在分娩镇痛高质量发展的各项工作中取得了满意成果。本文主要介绍北京协和医院分娩镇痛相关经验,具体包括:(1)合理调配人员安排,多学科联动制定标准化诊疗流程,为安全分娩提供舒适度保障;(2)完善危重孕产妇、新生儿救治方案,为安全分娩保驾护航;(3)传递先进的教学理念,将分娩镇痛培训与救治演练落到实处;(4)开展教育与科普讲座,帮助产妇树立科学分娩镇痛观。希望该经验分享可为我国各级诊疗机构提供参考和借鉴。

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。

黄豆袋热敷联合合谷穴按摩在产程活跃期中的镇痛效果

目的探讨黄豆袋热敷联合合谷穴按摩在产程活跃期中的镇痛效果。方法选取初产妇100例作为研究对象,随机分为对照组和观察组,各50例。给予对照组综合干预方法,包括心理疗法、体位管理和拉玛泽呼吸法,在对照组的基础上于产程活跃期给予观察组黄豆袋热敷联合合谷穴按摩。比较两组的镇痛效果、顺产及中转行剖宫产比例,以及顺产产妇产程活跃期至胎儿娩出时间、阴道出血量。结果观察组产妇的疼痛程度轻于对照组,顺产比例高于对照组,顺产产妇的产程活跃期至胎儿娩出时间、阴道出血量短于或少于对照组(P<0.05)。结论在心理疗法、体位管理、拉玛泽呼吸法基础上,在产程活跃期辅以黄豆袋热敷联合合谷穴按摩可缓解初产妇的疼痛感,提高自然分娩率,缩短产程,减少产后出血量。

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。