静脉注射对乙酰氨基酚作为左旋布比卡因和芬太尼患者自控硬膜外镇痛在分娩中的辅助手段：一项随机对照研究。

I.V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study.

机构信息

Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.

Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India

出版信息

Br J Anaesth. 2016 Nov;117(5):617-622. doi: 10.1093/bja/aew311.

DOI:10.1093/bja/aew311

PMID:27799176

Abstract

BACKGROUND

Use of i.v. paracetamol for postoperative pain is well documented, but it is unclear if it can reduce the consumption of opioids during patient-controlled epidural analgesia (PCEA) in labouring parturients.

METHODS

In this randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital, parturients were randomly assigned to two groups of 40 each, to receive either 1000 mg (100 ml) i.v. paracetamol or 100 ml normal saline as placebo, 30 min before the procedure. After insertion of the epidural catheter, all patients received 10 ml of levobupivacaine 0.1% with 2 μg ml-1 fentanyl, followed by continuous background epidural infusion of 6 ml h-1 with a provision of patient-controlled bolus 5 ml of same drug with a lock-out interval of 12 min.The primary outcome was hourly mean consumption of levobupivacaine and fentanyl mixture (ml.h-1). Secondary outcomes included pain score ,: sensory and motor block, haemodynamic parameters of mother, duration of second stage of labour, mode of delivery, Apgar scores, foetal heart rate and adverse effects.

RESULTS

The hourly mean drug consumption in the Paracetamol group was significantly lower as compared with the Placebo group (7.03 ml.h-1, SD 0.83 vs. 8.12 ml.h-1, SD 1.34; p < 0.001). The mean number of boluses taken were also significantly less in the paracetamol group (1.00, SD 0.93 vs. 1.43, SD 0.90; p = 0.036). Pain scores decreased in both the groups without significant inter-group differences.

CONCLUSIONS

Use of 1000 mg i.v. paracetamol decreases the mean hourly drug consumption through epidural route. Thus i.v. paracetamol is a safe and effective adjunct to PCEA in labour analgesia.

CLINICAL TRIAL REGISTRATION

Clinical Trials Registry-India (http://ctri.nic.in/Clinicaltrials/login.php), trial registration number 2013/09/003968.

摘要

背景

静脉注射对乙酰氨基酚在术后疼痛中的应用已有充分的文献记载，但尚不清楚其是否能减少产妇自控硬膜外镇痛（PCEA）期间阿片类药物的消耗。

方法

本研究为三级保健医院进行的一项随机、双盲、安慰剂对照临床试验，将产妇随机分为两组，每组 40 例，分别在操作前 30 分钟给予 1000mg（100ml）静脉注射对乙酰氨基酚或 100ml 生理盐水作为安慰剂。硬膜外导管插入后，所有患者均接受 10ml 0.1%左旋布比卡因加 2μg/ml 芬太尼，随后以 6ml/h 的速度持续硬膜外背景输注，并提供患者自控 5ml 相同药物的推注，锁定间隔 12min。主要结局是每小时平均消耗的左布比卡因和芬太尼混合物（ml/h）。次要结局包括疼痛评分、感觉和运动阻滞、母亲的血液动力学参数、第二产程持续时间、分娩方式、阿普加评分、胎儿心率和不良反应。

结果

与安慰剂组相比，对乙酰氨基酚组的每小时平均药物消耗明显较低（7.03ml/h，标准差 0.83 与 8.12ml/h，标准差 1.34；p<0.001）。对乙酰氨基酚组使用的推注次数也明显较少（1.00，标准差 0.93 与 1.43，标准差 0.90；p=0.036）。两组的疼痛评分均有下降，但组间无显著差异。