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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Comparision of Intermittent Bolus versus Continuous Infusion of Epidural Labour Analgesia by 0.15% Ropivacaine and Fentanyl: A Randomised Clinical Study
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Comparision of Intermittent Bolus versus Continuous Infusion of Epidural Labour Analgesia by 0.15% Ropivacaine and Fentanyl: A Randomised Clinical Study

机译：0.15％Ropivacaine和Fentanyl的间断推注与连续输注硬膜外镇痛的比较：随机临床研究

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Epidural labour analgesia is considered to be the most effective method to produce pain relief during labour. Programmed Intermittent Epidural Bolus (PIEB) has been observed to have many advantages over Continuous Epidural Infusion (CEI) like reduced incidence of breakthrough pain, local anaesthetic usage, instrumental delivery, shorter second stage of labour and more maternal satisfaction. Administration of local anaesthetic solution as PIEB at regular intervals has shown to spread more extensively in the epidural space compared to CEI, possibly enabling greater efficacy.Aim: To compare the intermittent bolus versus Continuous Infusion of Epidural Labour Analgesia with the primary objective to measure the total local anaesthetic consumption of 0.15% ropivacaine and fentanyl.Materials and Methods: The randomised double blind study was carried out on parturient in Obstetrics and Gynaecology Department at Fortis Hospital, Bengaluru, Karnataka, India from June 2014 to June 2015. The present study compared 60 primiparous women (divided into two groups of 30 each). Labour analgesia was provided by bolus of 12 mL of 0.15% ropivacaine and 2 μg/mL fentanyl, after one hour of the initial bolus dose, Group I parturients received 8 mL of 0.15% ropivacaine with fentanyl 2 μg/mL hourly and Group C parturients received same solution as continuous infusion immediately. If patient complained of pain or Visual Analog Scale (VAS) score ≥ 4, additional 8 mL of the same solution was given. Total dose of 0.15% ropivacaine, number of rescue doses, pain scores, motor block and second stage of labour were compared.Results: The mean age in Group I was 27.93±1.14 and in Group C was 27.87±1.28 years. Total dose of ropivacaine in Group I was 41.45±14.62 mg and in Group C was 59.20±21.12mg (p-value=0.0004). In Group C, at 2nd hour, VAS score (3.03±1.88) was more compared to intermittent bolus group (1.40±2.02), which was statistically significant (p-value=0.002). No motor block was observed in Group I, but two parturients in Group C had modified Bromage score of 4. Second stage of labour was significantly reduced in Group I compared to Group C (p-value<0.001). Less instrumental delivery and more maternal satisfaction was observed in Group I.Conclusion: Intermittent bolus group required less rescue doses hence, less total local anaesthetic dose with better analgesic efficacy (p=0.002).
机译：硬膜外植入镇痛被认为是在劳动期间产生疼痛缓解的最有效的方法。已经观察到编程间歇性硬膜外推注（PIDB）对连续硬膜外输液（CEI）具有许多优点，如降低突破性疼痛，局部麻醉使用，工具交付，劳动力和更多孕产妇满意度的较短阶段。局部麻醉解决方案以规则的间隔施用，与CEI相比，在硬膜外空间中展示更广泛，可能是更大的效率。[可以比较间歇式推注与外膜危性镇痛的连续输注，主要目的是测量总局部麻醉消耗量为0.15％Ropivacaine和Fentanyl.materials和方法：从2014年6月到2015年6月到2015年6月，对Fortis医院，班尔堡，卡纳塔克邦的妇产科职业和妇科部门进行了随机双盲研究。目前的研究比较了60名孕妇（分为每组30分）。在初始推注剂量1小时后，通过12mL 0.15％罗哌卡因和2μg/ ml芬太尼提供的劳动镇痛，I基团占偏芬太尼的8ml 0.15％Ropivacaine，C小时和C组成部分立即接收相同的解决方案作为连续输注。如果患者抱怨疼痛或视觉模拟量表（VAS）得分≥4，则给出另外8mL相同的溶液。比较总剂量为0.15％Ropivacaine，抢救剂量，疼痛评分，电机块和第二阶段的劳动力。结果：I组的平均年龄为27.93±1.14，C组为27.87±1.28岁。 I基团中的总剂量为41.45±14.62mg，C组为59.20±21.12mg（p值= 0.0004）。在C组中，与第2小时，与间歇式推注组（1.40±2.02）相比，VAS得分（3.03±1.88）均有统计学意义（P值= 0.002）。在I组中没有观察到电机块，但C组中的两种群体已经改性溴比得分为4.与C组（P值<0.001）相比，I基团的第二阶段显着降低。在第I基团中观察到较少的工具递送和更多的产妇满意度。结论：间歇式推杆组需要较少的救援剂量，因此较少的总临床疗效效果（P = 0.002）。

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