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Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

机译：剖宫产术后最高镇痛需求期间鞘内注射芬太尼的镇痛效果

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Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain.Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9–51.6).The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.
机译：剖宫产（CS）是女性患者中最常见的手术方法之一。我们的目的是评估CS后最大的术后镇痛需求期间，鞘内注射芬太尼的术后镇痛效果。这一时期是通过对患者自控镇痛（PCA）使用情况的详细分析来定义的。该双盲，安慰剂自控，平行组随机试验包括60名计划进行选择性CS的产妇。参与者接受了布比卡因补充生理盐水（对照组）或芬太尼25μg（芬太尼组）的脊髓麻醉。为了评估主要终点，我们测量了最大PCA哌啶需求期间的总哌啶消耗量。为了验证次要终点，我们在其他时间窗内记录了静脉PCA需求量，有效镇痛的持续时间，通过视觉模拟评分法评估的疼痛评分，阿片类药物副作用，血液动力学变化，新生儿Apgar评分和术中疼痛。 1小时的PCA阿片类药物需求表明，对照组患者中对止痛药的最大需求发生在手术后的前12小时内。与对照组相比，芬太尼组的患者在此期间的阿片类药物消耗量显着减少，并且有效镇痛时间延长。这些组在视觉模拟量表，与镇痛有关的副作用（恶心/呕吐，瘙痒，过度镇静和呼吸抑制）的发生率和新生儿Apgar评分方面相似。每组1例患者出现轻度呼吸抑制。在芬太尼组中，术中出现疼痛的患者更少（3％vs 23％；相对危险度6.8，95％置信区间0.9-51.6）。在接受CS麻醉的患者中，麻醉后的最初12小时内对术后镇痛的需求最大。椎管内麻醉中添加鞘内芬太尼可有效用于术中镇痛，并在CS术后镇痛需求最高的时期减少阿片类药物的消耗，而不会增加母体或新生儿的副作用。我们建议在医疗中心使用鞘内芬太尼用于CS，目前不鞘内使用吗啡或其他阿片类药物。

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