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首页> 美国卫生研究院文献>British Medical Journal >Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction.
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Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction.

机译：布比卡因与布比卡因加芬太尼用于硬膜外镇痛：对产妇满意度的影响。

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OBJECTIVE--To compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labour and to evaluate factors in addition to analgesia that may influence maternal satisfaction. DESIGN--A prospective randomised pilot study. SETTING--Birmingham Maternity Hospital. SUBJECTS--85 primiparous women who requested epidural analgesia in labour and their babies. INTERVENTIONS--Group 1 mothers were treated with bupivacaine conventionally, group 2 mothers with bupivacaine and fentanyl in a more complex way designed to provide satisfactory analgesia but with less troublesome side effects. MAIN OUTCOME MEASURES--Overall maternal satisfaction, maternal perception of epidural analgesia and its side effects, and aspects of mothers' psychological states during labour, quantified using 100 mm visual linear analogue scales; the frequency of normal and operative deliveries; and measurements of neonatal wellbeing. RESULTS--Satisfaction was higher in group 2 mothers (median group difference +3 mm, 95% confidence interval +1 to +5, p = 0.012): this was associated with more normal deliveries (difference between proportions 0.23, 95% confidence interval +0.03 to +0.42); greater self control (median group difference -7 mm, -17 to -2, p = 0.003); and reduced unpleasantness of motor blockade (-10 mm, -19 to -5, p less than 0.001), sensory blockade (-5 mm, -11 to -2, p = 0.002) and shivering (-5 mm, -18 to 0, p = 0.046) at the expense of mild itching (0 mm, 0 to 0, p less than 0.001). Group 1 mothers found restricted movements more unpleasant (-1 mm, -11 to 0, p = 0.006) and were more sleepy (-4 mm, -20 to 0, p = 0.032). The addition of fentanyl to bupivacaine reduced the requirement for local anaesthetic (-33 mg, -55 to -15, p less than 0.001) without compromising analgesia. No adverse effects in neonates were attributed to the use of fentanyl. CONCLUSIONS--The already high maternal satisfaction from conventional epidural analgesia can be improved; epidural fentanyl may be combined with bupivacaine to reduce operative deliveries and confer other advantages that may increase maternal satisfaction. Further investigations should be performed to determine the exact mechanisms of these findings and, in particular, to develop a safe method of delivering such analgesia to women.
机译：目的比较硬膜外芬太尼和布比卡因与单独使用布比卡因的组合在分娩时对硬膜外镇痛的作用，并评估除镇痛外可能影响母体满意度的因素。设计-前瞻性随机试验研究。地点-伯明翰妇产医院。受试者-85名初产妇，她们在分娩及婴儿时要求硬膜外镇痛。干预措施-第1组母亲常规接受布比卡因治疗，第2组母亲以较复杂的方式接受布比卡因和芬太尼治疗，旨在提供令人满意的镇痛效果，但副作用较少。主要观察指标-总体母亲满意度，母亲对硬膜外镇痛及其副作用的知觉以及分娩过程中母亲心理状态的各个方面，均使用100毫米视觉线性模拟量表进行量化；正常和手术分娩的频率；和测量新生儿的健康状况。结果-第2组母亲的满意度较高（中位数差异为+3 mm，95％置信区间+1至+ 5，p = 0.012）：这与更多的正常分娩有关（比例之间的差异0.23、95％置信区间+0.03至+0.42）；更大的自我控制能力（中位数差异为-7 mm，-17至-2，p = 0.003）;并减少了运动障碍（-10 mm，-19至-5，p小于0.001），感觉障碍（-5 mm，-11至-2，p = 0.002）和发抖（-5 mm，-18至0，p = 0.046），以轻度瘙痒为代价（0 mm，0至0，p小于0.001）。第一组的母亲发现受限运动更不愉快（-1 mm，-11至0，p = 0.006），并且更困倦（-4 mm，-20至0，p = 0.032）。在布比卡因中添加芬太尼可降低局部麻醉的需要量（-33 mg，-55至-15，p小于0.001），而不会影响镇痛效果。芬太尼的使用对新生儿没有不良影响。结论–常规硬膜外镇痛对原本已经很高的产妇满意度可以改善；硬膜外芬太尼可与布比卡因合用，以减少手术分娩并赋予其他可能增加产妇满意度的优势。应该进行进一步的调查以确定这些发现的确切机制，尤其是要开发出向女性提供这种镇痛作用的安全方法。

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