Pan Li, Xiaoting Ma, Meng Zhang, Longlu Cao, Ran Duan, Jianli Li
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引用次数: 0
摘要
背景：硬膜外麻醉是最常用的分娩镇痛方法，经常辅以各种局麻药，不同局麻药方案的镇痛效果和安全性不同。通过网络荟萃分析，比较不同局麻方案缓解分娩疼痛的疗效和不良反应。方法：我们系统地检索了四个电子数据库（PubMed、EMBASE、Web of Science和Cochrane Library），从数据库建立到2025年3月3日的随机对照试验。该研究包括在硬膜外麻醉下进行无痛分娩的18至35岁的患者。结果：meta分析共纳入59项研究，涉及6972例患者。与大多数其他麻醉方案相比，Ropivacaine_Dexmedetomidine_Sufentanil （Rop_Dex_Suf）联合用药在阻滞后30min降低视觉模拟量表（VAS）评分最有效，速度最快。罗哌卡因右美托咪定（Rop_Dex）组阵痛持续时间最长。布比卡因-哌嗪（Bpv_Pet）、布比卡因-右美托咪定（Bpv_Dex）、芬太尼（Fen）和布比卡因- diamorphine （Bpv_DiaMor）的恶心、呕吐、低血压和瘙痒发生率最低。此外，布比卡因e_右美托咪定（Bpv_Dex）、罗哌卡因e_右美托咪定（Rop_Dex）和罗哌卡因e_右美托咪定-舒芬太尼（Rop_Dex_Suf）的镇痛效果和安全性均较好。结论：我们的研究表明，罗哌卡因、右美托咪定和舒芬太尼联合使用是缓解分娩疼痛最有效的方案。尽管如此，鉴于对某些方案的研究数量有限，预计未来还会有更多高质量、大规模的随机对照试验（rct）来证实我们的结论。普洛斯彼罗注册号：CRD42023459538。临床试验号：不适用。
Comparative efficacy and safety of local anesthesia combinations for labor pain relief: a network meta-analysis.
Background: Epidural anesthesia stands out as the most commonly employed approach for labor analgesia, frequently complemented by various local anesthetics, and the analgesic effectiveness and safety profiles of distinct local anesthetic regimens are different. To compare the efficacy and adverse reactions of different local anesthetic regimens in relieving labor pain by performing a network meta-analysis.
Methods: We systematically searched four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Library) for randomized controlled trials from the inception of the databases up to March 3, 2025. Included in the study were patients aged 18 to 35 years who underwent painless delivery under epidural anesthesia.
Results: The meta-analysis included a total of 59 studies involving 6972 patients. The combination of Ropivacaine_Dexmedetomidine_Sufentanil (Rop_Dex_Suf) was the most effective and fast in reducing Visual Analog Scale (VAS) scores at 30 min after block, compared to most other anesthesia schemes. Labor pain lasted for the longest time with Ropivacaine_Dexmedetomidine(Rop_Dex). Meanwhile, Bupivacaine_Pethidine(Bpv_Pet), Bupivacaine_Dexmedetomidine(Bpv_Dex), Fentanyl(Fen), and Bupivacaine_Diamorphine(Bpv_DiaMor) had the lowest incidence of nausea, vomiting, hypotension, and pruritus. Besides, Bupivacaine_Dexmedetomidine(Bpv_Dex), Ropivacaine_Dexmedetomidine(Rop_Dex), and Ropivacaine_Dexmedetomidine_Sufentanil (Rop_Dex_Suf) have demonstrated outstanding analgesic efficacy and safety.
Conclusions: Our study demonstrates that the combination of ropivacaine, dexmedetomidine, and sufentanil is the most effective regimen for alleviating labor pain. Nonetheless, given the limited number of studies on certain protocols, additional high-quality, large-scale randomized controlled trials (RCTs) are anticipated to substantiate our conclusion in the future.
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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