IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Anthony Chau, Lawrence C Tsen
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引用次数: 0

摘要

回顾的目的:近年来,神经轴向分娩镇痛的起始技术侧重于提高镇痛质量,同时最大限度地减少并发症。本综述旨在总结有关标准硬膜外(EPL)、脊髓-硬膜外联合(CSE)和硬膜穿刺硬膜外(DPE)技术的最新证据,强调其优点、风险以及在当代产科麻醉护理中的相关性:最新研究结果:DPE 技术结合了 CSE 和 EPL 技术的优点,具有独特的价值。与 EPL 相比,DPE 和 CSE 技术需要用脊髓穿刺针进行硬膜穿刺,由此产生的硬膜外-椎管内导管可实现镇痛剂的转移,从而提供更快的起效时间、更早的骶骨覆盖、更好的导管功能以及更快的硬膜外延伸至手术麻醉。此外,通过限制 CSE 技术的鞘内给药剂量,DPE 技术降低了胎儿心动过缓和瘙痒的风险。DPE 技术提供了一种新颖的替代方法,可在提供高质量镇痛的同时将并发症降至最低。虽然 DPE 技术的优点正日益得到认可,但更多的比较研究将更好地支持麻醉医师在不同的临床情况下选择最合适的技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neuraxial initiation techniques for labor analgesia: Comparative insights on standard epidural, combined spinal-epidural and dural puncture epidural analgesia.

Purpose of review: In recent years, initiation techniques for neuraxial labor analgesia have focused on enhancing analgesic quality while minimizing complications. This review aims to summarize recent evidence on the standard epidural (EPL), combined spinal-epidural (CSE), and dural puncture epidural (DPE) techniques, emphasizing their benefits, risks, and relevance in contemporary obstetric anesthesia care.

Recent findings: The DPE technique offers unique values, combining the advantages from CSE and EPL techniques. DPE and CSE, compared with EPL, techniques involve a dural puncture with a spinal needle, and the resulting epidural-intrathecal conduit enables translocation of analgesic agents, providing faster onset, earlier sacral coverage, better catheter function, and more rapid epidural extension to surgical anesthesia. Moreover, by limiting the intrathecal dose administered with the CSE technique, the DPE technique lowers the risks of fetal bradycardia and pruritus.

Summary: EPL and CSE techniques are widely used for neuraxial labor analgesia. The DPE technique offers a novel alternative, delivering high-quality analgesia with minimal complications. While the benefits of the DPE technique are increasingly being recognized, additional comparative research will better support anesthesiologists in selecting the most appropriate technique across diverse clinical scenarios.

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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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