引产或催产是否会影响鞘内阿片类药物的镇痛效果?回顾性队列研究

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Lotta Salmi, Riina Jernman, Antti Väänänen
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引用次数: 0

摘要

背景。与自然分娩相比,引产或催产可能会引起更多的宫缩疼痛,这对分娩早期仅靠脊髓阿片类药物镇痛的疗效提出了挑战。因此,我们研究了接受鞘内阿片类药物神经镇痛的产妇在自然分娩和人工引产或助产过程中的镇痛效果和产妇满意度。方法。本研究使用了四十名在分娩早期(宫颈扩张≤5厘米)通过脊髓-硬膜外联合方法接受鞘内阿片类药物(舒芬太尼5微克或芬太尼20微克)的产妇作为研究对象。分娩镇痛开始后 30 分钟,用 0-100 视觉模拟量表测量产妇的满意度和宫缩时的疼痛。此外,还测量了产科参数(推进分娩的方法、宫颈扩张、催产素的使用、脊髓阿片类药物的有效时间和分娩结果)。结果。在 40 名产妇中,18 名为自然分娩,22 名为引产或催产(事先扩张宫颈、人工破膜或在开始神经镇痛时输注催产素)。在镇痛开始 30 分钟后,与引产或催产素催产相比,自然分娩的平均疼痛评分较低(6.4 (±12.8) vs 29.6 (±30.6) mm,P = 0.005),满意度评分较高(96.9 (±5.3) vs 81.1 (±28.0) mm,P = 0.024)。产妇的产程阶段相似,产程进展速度相似。结论对于非自然分娩的产妇,仅使用鞘内阿片类药物启动分娩镇痛可能不足以提供足够的镇痛效果,因此应考虑使用阿片类药物和局麻药的混合物进行鞘内或硬膜外镇痛。该试验已注册为 NCT02885350。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Does Induction or Augmentation of Labor Affect the Analgesic Efficacy of Intrathecal Opioids?: A Retrospective Cohort Study

Does Induction or Augmentation of Labor Affect the Analgesic Efficacy of Intrathecal Opioids?: A Retrospective Cohort Study

Background. Induction or augmentation of labor may cause more painful contractions compared to spontaneous labor and pose a challenge to the efficacy of analgesia provided by spinal opioids alone in the early phase of labor. Therefore, we studied the analgesic efficacy and maternal satisfaction during spontaneous and artificially induced or augmented delivery in parturients receiving neuraxial analgesia with intrathecal opioids. Methods. A forty-parturient cohort that received intrathecal opioid (sufentanil 5 µg or fentanyl 20 µg) by the combined spinal-epidural method at an early phase of labor (cervical dilatation ≤5 cm) was used for this post hoc study. Maternal satisfaction and pain during contractions were measured on 0–100 visual analog scale at 30 minutes after the initiation of labor analgesia. Obstetric parameters (methods used to advance labor, cervical dilatation, use of oxytocin, effective time of spinal opioids, and labor outcome) were also measured. Results. Of the 40 parturients, 18 had spontaneous labor and 22 had induced or augmented labor (prior cervical dilatation, artificial rupture of membranes, or oxytocin infusion at the time of neuraxial analgesia initiation). Spontaneous labor associated with lower mean pain scores (6.4 (±12.8) vs 29.6 (±30.6) mm, P = 0.005) and higher satisfaction scores (96.9 (±5.3) vs 81.1 (±28.0) mm, P = 0.024) compared to induced or oxytocin augmented labor at 30 minutes after the initiation of analgesia. The parturients were at a similar stage of labor, and their labor progressed at a similar rate. Conclusions. In parturients undergoing nonspontaneous labor, the initiation of labor analgesia by intrathecal opioids alone may not be sufficient for adequate analgesia and either intrathecal or epidural analgesia with a mixture of opioid and local anesthetic should be considered in this population. This trial is registered with NCT02885350.

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来源期刊
CiteScore
4.10
自引率
5.00%
发文量
226
审稿时长
6 months
期刊介绍: The Journal of Clinical Pharmacy and Therapeutics provides a forum for clinicians, pharmacists and pharmacologists to explore and report on issues of common interest. Reports and commentaries on current issues in medical and pharmaceutical practice are encouraged. Papers on evidence-based clinical practice and multidisciplinary collaborative work are particularly welcome. Regular sections in the journal include: editorials, commentaries, reviews (including systematic overviews and meta-analyses), original research and reports, and book reviews. Its scope embraces all aspects of clinical drug development and therapeutics, including: Rational therapeutics Evidence-based practice Safety, cost-effectiveness and clinical efficacy of drugs Drug interactions Clinical impact of drug formulations Pharmacogenetics Personalised, stratified and translational medicine Clinical pharmacokinetics.
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