Clinical effect of oxycodone combined with ropivacaine for epidural labor analgesia
-
摘要: 目的 比较羟考酮复合罗哌卡因与舒芬太尼复合罗哌卡因在硬膜外分娩镇痛中的有效性与安全性。 方法 选取80例单胎妊娠的孕周≥37周的产妇为研究对象,随机分为对照组和观察组,每组40例。对照组采用0.5 μg/mL舒芬太尼复合0.08%罗哌卡因8 mL行硬膜外分娩镇痛,观察组采用0.2 mg/mL羟考酮复合0.08%罗哌卡因行硬膜外分娩镇痛。比较2组镇痛起效时间、首次镇痛持续时间、自控镇痛泵追加给药次数、会阴侧切缝合时局麻药使用率、产妇满意度及配合度、产妇不良反应、新生儿Apgar评分及脐动脉血pH值。 结果 与对照组比较,观察组镇痛时间长,爆发痛发生率低,自控镇痛泵追加给药次数少,会阴侧切缝合时局麻药使用率低,孕妇满意度与配合度高,差异均有统计学意义(P<0.05); 观察组高血压发生率低于对照组,皮肤瘙痒发生率高于对照组,差异均有统计学意义(P<0.05); 2组新生儿Apgar评分、脐动脉血pH值比较,差异无统计学意义(P>0.05)。 结论 羟考酮复合罗哌卡因硬膜外分娩镇痛的效果及持续时间优于舒芬太尼复合罗哌卡因,且不会对新生儿安全造成不良影响。Abstract: Objective To compare the efficacy and safety of oxycodone combined with ropivacaine and sufentanyl combined with ropivacaine in epidural labor analgesia. Methods Eighty pregnant women with gestational age ≥37 weeks and single pregnancy were recruited, and were randomly divided into control group and observation group. The control group(n=40)adopted 0.5 μg/mL sufentanil combined with 0.08%ropivacaine for 8 mL for epidural labor analgesia and observation group(n=40)received 0.2 mg/mL oxycodone combined with 0.08%ropivacaine for epidural labor analgesia. The onset time of analgesia, duration of initial analgesia, additional times of analgesia pump, application rate of local anesthetics during suturing in perineotomy, maternal satisfaction and coordination degree, maternal adverse reactions, newborn Apgar score, umbilical arterial blood pH value were compared between the two groups. Results Compared with control group, observation group had a longer analgesia time, a lower incidence of pain outbreak, a less number of additional analgesia pump, a lower rate of additional application of local anesthetics, and a higher degree of satisfaction and coordination among pregnant women(P<0.05). The incidence of hypertension was significantly higher,and incidence of pruritus in the observation group was significantly lower than that in control group(P<0.05). There were no significant differences in Apgar score and pH value of umbilical artery between the two groups(P>0.05). Conclusion Oxycodone combined with ropivacaine for epidural labor analgesia has better effect and duration than sufentanil combined with ropivacaine, and has no adverse effects on neonatal safety.
-
Keywords:
- epidural analgesia /
- labor analgesia /
- oxycodone /
- sufentanil /
- ropivacaine
-
-
CHEN Y S, BU H, WU Y, et al. Effects of spinal epidural block combined with epidural analgesia on maternal prolactin and colostrum in cesarean section and painless labor[J]. Clin Med, 2017, 37: 37-39.
HE L, XU J M, LIU S M, et al. Intrathecal dexmedetomidine alleviates shivering during cesarean delivery under spinal anesthesia[J]. Biol Pharm Bull, 2017, 40(2): 169-173.
WANG C, LIU S, HAN C, et al. Effect and placental transfer of dexmedetomidine during Caesarean section under epidural anaesthesia[J]. J Int Med Res, 2017, 45(3): 964-972.
LOGTENBERG S, OUDE R K, VERHOEVEN C J, et al. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence trial[J]. BJOG, 2017, 124(4): 652-660.
BOSTRÖM E, HAMMARLUND-UDENAES M, SIMONSSON U S H. Blood-brain barrier transport helps to explain discrepancies in in vivo potency between oxycodone and morphine[J]. Anesthesiology, 2008, 108(3): 495-505.
STAAHL C, CHRISTRUP L L, ANDERSEN S D, et al. A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model[J]. Pain, 2006, 123(1): 28-36.
STAAHL C, DIMCEVSKI G, DUE ANDERSEN S, et al. Differential effect of opioids in patients with chronic pancreatitis: an experimental pain study[J]. Scand J Gastroenterol, 2007, 42(3): 383-390.
张莹, 葛圣金. 羟考酮对罗哌卡因硬膜外分娩镇痛的影响[J]. 复旦学报: 医学版, 2019, 46(2): 243-246. ZHONG H Y, YANG Z Y, ZHANG W. Effects of adding oxycodone to ropivacaine on labor analgesia: a randomized controlled trialEffects of adding oxycodone to ropivacaine on labor analgesia: a randomized controlled trial[J]. Clin J Pain, 2020, 36(2): 96-100.
SNG B, KWOK S, MATHUR D, et al. Comparison of epidural oxycodone and epidural morphine for post-Caesarean section analgesia: a randomised controlled trial[J]. Indian J Anaesth, 2016, 60(3): 187-193.
冯善武, 王朝晖, 沈晓凤. 硬膜外分娩镇痛的新进展[J]. 中华麻醉学杂志, 2019, 39(12): 1526-1530. BOULIER V, GOMIS P, LAUTNER C, et al. Minimum local analgesic concentrations of ropivacaine and levobupivacaine with sufentanil for epidural analgesia in labour[J]. Int J Obstet Anesth, 2009, 18(3): 226-230.
GUO S, LI B, GAO C, et al. Epidural analgesia with bupivacaine and fentanyl versus ropivacaine and fentanyl for pain relief in labor: a meta-analysis[J]. Medicine(Madr), 2015, 94(23): e880.
刘梅, 侯玉萍. 镇痛分娩临床应用的研究进展[J]. 医学综述, 2019, 25(24): 4960-4964. ROSS F B, SMITH M T. The intrinsic antinociceptive effects of oxycodone appear to be kappa-opioid receptor mediated[J]. Pain, 1997, 73(2): 151-157.
SCHMIDT-HANSEN M, BENNETT M I, ARNOLD S, et al. Oxycodone for cancer-related pain[J]. Cochrane Database Syst Rev, 2017, 8(8): CD003870.
IRIAH S C, TRIVEDI M, KENKEL W, et al. Oxycodone exposure: a magnetic resonance imaging study in response to acute and chronic oxycodone treatment in rats[J]. Neuroscience, 2019, 398: 88-101.
RUAN X, MANCUSO K F, KAYE A D. Revisiting oxycodone analgesia: a review and hypothesis[J]. Anesthesiol Clin, 2017, 35(2): e163-e174.
GKEGKES I D, MINIS E E, IAVAZZO C. Oxycodone/naloxone in postoperative pain management of surgical patients[J]. J Opioid Manag, 2018, 14(1): 52-60.
KOKKI M, FRANCO M G, RAATIKAINEN K, et al. Intravenous oxycodone for pain relief in the first stage of labour - maternal pharmacokinetics and neonatal exposure[J]. Basic Clin Pharmacol Toxicol, 2012: 111(3): 182-188.
KINNUNEN M, KOKKI H, HAUTAJÄRVI H, et al. Oxycodone pharmacokinetics and fetal exposure after intravenous or epidural administration to the ewe[J]. Acta Obstet Gynecol Scand, 2018, 97(10): 1200-1205.
SEATON S, REEVES M, MCLEAN S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels[J]. Aust N Z J Obstet Gynaecol, 2007, 47(3): 181-185.
-
期刊类型引用(3)
1. 侯蒙蒙，刘亚利. 术前盐酸戊乙奎醚预处理在腹腔镜子宫全切术中的应用分析. 华夏医学. 2024(01): 116-121 . 
百度学术
2. 刘焰，李国妍，陈超. 利多卡因对脑胶质瘤细胞恶性生物学行为的影响. 湖南师范大学学报(医学版). 2024(03): 16-21 . 百度学术
3. 张艳锋，张岚，韩辉. 银杏叶片联合利多卡因治疗周围性眩晕的临床效果及对患者情绪与前庭功能的影响. 临床合理用药杂志. 2022(32): 15-18 . 百度学术
其他类型引用(3)
计量
- 文章访问数: 282
- HTML全文浏览量: 80
- PDF下载量: 7
- 被引次数: 6
下载:
苏公网安备 32100302010246号
