Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study
肥胖产妇穿刺硬脊膜的硬膜外技术与标准硬膜外技术的分娩镇痛质量:一项双盲随机对照研究
Background: The dural puncture epidural technique may improve analgesia quality by confirming midline placement and increasing intrathecal translocation of epidural medications. This would be advantageous in obese parturients with increased risk of block failure. This study hypothesizes that quality of labor analgesia will be improved with dural puncture epidural compared to standard epidural technique in obese parturients.
背景:硬膜穿刺硬膜外技术可以通过确认中线位置和增加硬膜外药物的鞘内转移来改善镇痛质量。这对于阻滞失败风险增加的肥胖产妇来说是有利的。本研究假设,与肥胖产妇的标准硬膜外技术相比,硬膜穿刺硬膜外技术可以提高分娩镇痛的质量。
Methods: Term parturients with body mass index greater than or equal to 35 kg∙m–2, cervical dilation of 2 to 7 cm, and pain score of greater than 4 (where 0 indicates no pain and 10 indicates the worst pain imaginable) were randomized to dural puncture epidural (using 25-gauge Whitacre needle) or standard epidural techniques. Analgesia was initiated with 15 ml of 0.1% ropivacaine with 2 µg ∙ ml–1 fentanyl, followed by programed intermittent boluses (6 ml every 45 min), with patient-controlled epidural analgesia. Parturients were blinded to group allocation. The data were collected by blinded investigators every 3 min for 30 min and then every 2 h until delivery. The primary outcome was a composite of (1) asymmetrical block, (2) epidural top-ups, (3) catheter adjustments, (4) catheter replacement, and (5) failed conversion to regional anesthesia for cesarean delivery. Secondary outcomes included time to a pain score of 1 or less, sensory levels at 30 min, motor block, maximum pain score, patient-controlled epidural analgesia use, epidural medication consumption, duration of second stage of labor, delivery mode, fetal heart tones changes, Apgar scores, maternal adverse events, and satisfaction with analgesia.
方法:体重指数大于或等于35 kg∙m-2、宫颈扩张2至7cm、疼痛评分大于4分(其中0表示无疼痛,10表示可想象的最严重疼痛)的足月产妇随机分为硬膜穿刺硬膜外技术(使用25号Whitacre 针)或标准硬膜外技术。使用15 ml 0.1%罗哌卡因和2 µg∙ml–1芬太尼开始镇痛,然后进行程序性间歇推注(每45分钟6 ml),并进行患者自控硬膜外镇痛。产妇对组分配不知情。数据由不知情的调查人员每3分钟收集一次,持续30分钟,然后每2小时收集一次,直至分娩。
主要结局是(1)不对称阻滞,(2)硬膜外追加量,(3)导管调整,(4)导管更换,和(5)剖宫产转为区域麻醉失败。
次要结局包括疼痛评分小于或等于1的时间、30分钟时的感觉水平、运动阻滞、最大疼痛评分、患者自控硬膜外镇痛药的使用、硬膜外药物消耗、第二产程持续时间、分娩方式、胎心音变化、Apgar 评分、产妇不良事件和镇痛满意度。
Results: Of 141 parturients randomized, 66 per group were included in the analysis. There were no statistically or clinically significant differences between the dural puncture epidural and standard epidural groups in the primary composite outcome (34 of 66, 52% vs. 32 of 66, 49%; odds ratio, 1.1 [0.5 to 2.4]; P = 0.766), its individual components, or any of the secondary outcomes.
结果:随机抽取141例产妇,每组66例纳入分析。硬膜穿刺组和标准硬膜外组在主要复合结果、其各个组成部分或任何次要结果方面,没有统计学或临床意义上的显著差异(34 / 66, 52% vs. 32 / 66, 49%; 优势比为1.1 [0.5 ~ 2.4]; P = 0.766)。
Conclusions: A lack of differences in quality of labor analgesia between the two techniques in this study does not support routine use of the dural puncture epidural technique in obese parturients.
结论:本研究中两种技术在分娩镇痛质量上的差异不支持在肥胖产妇中常规使用穿刺硬脊膜的硬膜外技术。
笔记/苏洋
排版/叮当丸子麻
A-5.22.pdf
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