Sacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial

IF 2.6 3区 医学 Q2 ANESTHESIOLOGY
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Abstract

Background

The dural puncture epidural (DPE) technique has been associated with better sacral analgesia compared with a traditional epidural (EPL) technique in laboring parturients. The aim of this study was to investigate whether DPE with a 27-gauge pencil-point needle compared with a traditional EPL technique produces more rapid bilateral sacral blockade in nulliparous parturients.

Methods

Patients were randomized to a DPE or EPL technique. Epidural analgesia in both groups was initiated with ropivacaine 0.1% and sufentanil 0.5 μg/mL (15 mL) and maintained via programmed intermittent epidural boluses. Analgesic blockade was tested bilaterally beginning 10 min after initiation, and then at predefined intervals until delivery. The presence of an S2 blockade at 20 min was the primary outcome.

Results

Among 108 (54 per group) patients enrolled, bilateral sacral (S2) blockade at 20 min was significantly more common in the DPE than in the EPL group [47 (87%) vs. 23 (43%), absolute risk reduction (ARR) 44%, 95% CI 28 to 60; P < 0.001]. Time to a numeric pain rating scale score (0–10 scale) ≤ 3 (20 [20,30] min in both groups, HR 1.15, 95% CI 0.77 to 1.15; P = 0.50), number of rescue doses [0 (0, 1) vs 0 (0, 1); P 0.08], and presence of bilateral S2 blockade at delivery were not significantly different between groups.

Conclusions

The DPE technique with a 27-gauge pencil-point spinal needle more often provides bilateral sacral blockade at 20 min following block initiation compared with the EPL technique. The time to adequate analgesia and need for supplemental analgesia did not appear to differ between techniques.

Abstract Image

Abstract Image

27 号铅笔尖硬膜外穿刺硬膜外镇痛或硬膜外镇痛对非顺产产妇的骶骨感觉阻滞:随机对照试验
背景硬膜穿刺硬膜外(DPE)技术与传统的硬膜外(EPL)技术相比,对临产孕妇的骶管镇痛效果更好。本研究旨在探讨使用 27 号铅笔尖针的硬膜外穿刺术与传统的 EPL 技术相比,是否能更快速地对无阴道的产妇进行双侧骶骨阻滞。两组患者均使用 0.1% 罗哌卡因和 0.5 μg/mL 舒芬太尼(15 mL)开始硬膜外镇痛,并通过程序化间歇硬膜外栓剂维持镇痛。镇痛阻滞测试从开始10分钟后的双侧开始,然后按预先确定的时间间隔进行,直至分娩。结果在 108 例(每组 54 例)入组患者中,DPE 组在 20 分钟内出现双侧骶骨 (S2) 阻滞的比例明显高于 EPL 组 [47 (87%) vs. 23 (43%),绝对风险降低 (ARR) 44%,95% CI 28 至 60;P < 0.001]。疼痛评分量表(0-10 级)≤ 3 分的时间(两组均为 20 [20,30] 分钟,HR 1.15,95% CI 0.77 至 1.15;P = 0.50)、抢救剂量次数 [0 (0, 1) vs 0 (0, 1);P 0.结论与 EPL 技术相比,使用 27 号铅笔尖脊柱针的 DPE 技术更常在阻滞开始后 20 分钟内提供双侧骶骨阻滞。不同技术的充分镇痛时间和补充镇痛需求似乎没有差异。
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来源期刊
CiteScore
4.70
自引率
7.10%
发文量
285
审稿时长
58 days
期刊介绍: The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.
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