Real-time analgesic efficacy and factors determining drug requirements of combined spinal-epidural analgesia for labor: a prospective cohort study.

IF 2.8 3区医学 Q2 ANESTHESIOLOGY

Journal of Anesthesia Pub Date : 2024-10-01 Epub Date: 2024-07-05 DOI:10.1007/s00540-024-03368-8

Shuzhen Wu, Yaxin Lu, Zijing Zhang, Linjia Zhong, Hongfei Dai, Changping Fang, Minli Huang, Zifeng Liu, Lingling Wu

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Abstract

Purpose: Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia.

Methods: This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed.

Results: Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m², and those with a primary or secondary education level.

Conclusion: Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia.

Clinical trial number and registry: Clinicaltrials.gov (ChiCTR2100051809).

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实时镇痛效果和决定脊柱硬膜外联合镇痛分娩药物需求的因素：一项前瞻性队列研究。

目的：脊柱硬膜外联合镇痛（CSEA）对分娩镇痛有效，但并不充分。本研究旨在评估分娩镇痛的实时镇痛效果、麻醉药物剂量的副作用以及产妇的满意度，为优化分娩镇痛提供参考：这是一项前瞻性、队列、单中心研究，共纳入了 3020 名接受 CSEA 分娩镇痛的产妇。对分娩疼痛视觉模拟量表（VAS）、实时麻醉药物剂量、副作用、不良分娩结局、影响平均药物剂量的因素以及产妇对CSEA的满意度进行了评估：总体而言，麻醉后第一小时的 VAS 产痛评分最低。初产妇在 4 小时后，多产妇在 3 小时后，VAS 评分均大于 3 分，但麻醉药物剂量并未同时达到允许的最大剂量。麻醉药物的平均用量与发热、尿潴留、宫缩乏力、活跃期延长、第二产程延长、阴道助产和产后出血呈正相关。20 岁以下、体重指数（BMI）≥ 24.9 kg/m2、小学或中学教育水平的女性平均麻醉药物用量最高：结论：适当的年龄指导和重视分娩镇痛教育、孕期体重管理以及分娩过程中根据 VAS 疼痛评分实时调整麻醉剂量可能会对分娩镇痛的满意度产生积极影响：临床试验编号和注册表：Clinicaltrials.gov (ChiCTR2100051809)。

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来源期刊

Journal of Anesthesia 医学-麻醉学

CiteScore

5.30

自引率

7.10%

发文量

112

审稿时长

3-8 weeks

期刊介绍： The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.