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首页> 外文期刊>Anaesthesia: Journal of the Association of Anaesthetists of Great Britain and Ireland >Combined spinal epidural vs epidural labour analgesia: Does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?
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Combined spinal epidural vs epidural labour analgesia: Does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?

机译：硬膜外硬膜外联合硬膜外分娩镇痛的联合镇痛：最初的鞘内镇痛会降低随后的硬膜外布比卡因的最低局部镇痛浓度吗？

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摘要

Summary Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 μg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 μg. Analgesia was assessed using a visual analogue pain score. When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia.
机译：总结与仅采用硬膜外技术相比，使用脊柱-硬膜外（CSE）联合技术进行的分娩镇痛可以减少随后的硬膜外布比卡因需求。我们比较了初始鞘内或硬膜外注射后硬膜外布比卡因的最低局部镇痛药浓度（MLAC）。在一项前瞻性，双盲研究中，将115名要求硬膜外镇痛的妇女随机分配接受硬膜外联合布比卡因20 mg和芬太尼40μg或鞘内注射布比卡因2.5 mg和芬太尼5μg的CSE。使用视觉模拟疼痛评分评估镇痛效果。当需要进一步镇痛时，给予布比卡因20 ml，并使用上下顺序分配技术确定浓度。硬膜外组布比卡因的MLAC为0.032％wt / vol（95％CI 0.020-0.044），而CSE组为0.047％wt / vol（95％CI 0.042-0.052）。与硬膜外镇痛相比，鞘内镇痛后第二次注射布比卡因的需要量增加了1.45（p = 0.026）。

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