Intravenous butorpbanol, meperidine, and their combination relieve pain and distress in women in labor
Intravenous butorpbanol, meperidine, and their combination relieve pain and distress in women in labor
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DOI：
10.1097/00000542-200505000-00021
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发表时间：
2005-05-01
期刊：
影响因子：
8.8
通讯作者：
Eisenach, JC
中科院分区：
文献类型：
--
作者：
Nelson, KE;Eisenach, JC
背景。全身性阿片类药物通常在分娩时使用，但其功效最近受到质疑。此外，实验室和临床研究为联合使用mu-和kappa-阿片受体激动剂镇痛提供了强有力的理论依据。因此，作者采用有效的强度和情感量表以及有效疼痛缓解的定义，研究了静脉注射哌替啶、布托啡诺及其联合用于分娩镇痛的疗效。方法：对健康的单胎足月妊娠孕妇进行主动分娩镇痛的研究。妇女被随机分配接受50mg哌替啶、1mg丁托啡诺或25mg哌替啶加0.5 mg丁托啡诺（n = 15/组）。疼痛强度采用0-10数值评定量表评估，情感程度采用比例描述性量表评估给药前和给药后第六次至第七次子宫收缩之间。结果：三种治疗方法均能减轻疼痛强度。单独使用布托啡诺并不能减轻疼痛的影响程度，而其他治疗方法却可以。在所有组中，疼痛强度的降低与情感程度之间存在显著的相关性，情感程度的降低大于强度的降低。总体而言，29%的女性表现出临床意义上的疼痛缓解，组间无差异。各组在阿片类药物引起的不良反应发生率上没有差异。结论：这些剂量的哌替啶和布托啡诺确实减轻了疼痛强度和情感程度，尽管少数患者在包括分娩妇女在内的多个患者群体中实现了有意义的疼痛缓解。这些药物的联合使用并没有提高它们的治疗效果。
Background. Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia.Methods: Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration.Results: All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects.Conclusions: These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.