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首页> 外文期刊>Chronobiology international >Biological rhythms of spinal-epidural labor analgesia
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Biological rhythms of spinal-epidural labor analgesia

机译：脊髓硬膜外分娩镇痛的生物节律

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Pain exhibits temporal variations in intensity due to multiple factors, including endogenous neuroendocrine and various external influences that vary over the 24h. Also, medications can vary in potency andor toxicity according to the time when they are administered. However, there is no consensus among studies regarding the 24-h pattern of analgesia during labor. Taking into account the time-of-day when labor analgesia is administered, this study aimed to answer two questions: (i) Is there diurnal variation in visual analogue scale (VAS)rated pain relief and duration of intrathecal analgesia in patients undergoing labor analgesia? (ii) If there is, what is the influence of the duration of labor on the diurnal variation of the level of pain relief and duration of intrathecal analgesia? This prospective cohort included 41 healthy, nulliparous women in the first stage of labor undergoing spinal-epidural (CSE) analgesia using fentanyl combined with bupivacaine. Subjects had an epidural catheter fitted for additional, patient-controlled analgesia (PCA) if their pain relief was unsatisfactory. The number of VAS assessments (n558) was divided into six time periods of the 24h. The adjusted coefficient of determination (r~2), the proportion of the variance explained by the association between the duration of labor and the temporal pattern of the outcomes variable, was 58 (r~20.58) for pain relief and 44 (r~20.44) for duration of intrathecal analgesia. The peak effect of labor analgesia occurred between 02:00 and 05:59h. However, the duration of intrathecal analgesia showed two peaks, i.e., at ～00:00 and ～12:00h. These results demonstrate that labor analgesia achieved by fentanyl combined with bupivacaine shows a diurnal pattern in pain relief and duration of spinal analgesia. However, part of these temporal patterns was explained by the association with duration of labor.
机译：由于多种因素，疼痛表现出强度的时间变化，包括内源性神经内分泌和各种在24小时内变化的外部影响。而且，药物的给药时间可能会因效力和毒性而异。然而，关于分娩过程中24小时镇痛模式的研究之间尚无共识。考虑到每天进行分娩镇痛的时间，本研究旨在回答两个问题：（i）进行分娩镇痛的患者的视觉模拟评分（VAS）缓解疼痛和鞘内镇痛持续时间是否存在昼夜变化？ （ii）如果有的话，分娩时间对疼痛缓解水平和鞘内镇痛时间的昼夜变化有何影响？该前瞻性队列研究包括41名健康，未分娩的妇女，这些妇女在分娩的第一阶段接受芬太尼联合布比卡因镇痛，进行脊柱硬膜外（CSE）镇痛。如果患者的疼痛缓解效果不理想，则为其硬膜外导管进行额外的患者自控镇痛（PCA）。 VAS评估次数（n558）分为24小时的六个时间段。调整后的确定系数（r〜2）（由分娩持续时间与结果变量的时间模式之间的关联解释的方差比例）对于疼痛缓解为58（r〜20.58），而对于疼痛缓解为44（r〜20.44） ）进行鞘内镇痛。分娩镇痛的高峰期发生在02:00至05：59h之间。然而，鞘内镇痛的持续时间显示了两个峰值，即〜00：00和〜12：00h。这些结果表明，通过芬太尼联合布比卡因实现的分娩镇痛在疼痛缓解和脊髓镇痛持续时间方面呈昼夜模式。但是，这些时间模式的一部分是通过与劳动时间的关系来解释的。

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