Analgesia, pruritus, and ventilation exhibit a dose-response relationship in parturients receiving intrathecal fentanyl during labor
Analgesia, pruritus, and ventilation exhibit a dose-response relationship in parturients receiving intrathecal fentanyl during labor
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DOI：
10.1097/00000539-199908000-00024
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发表时间：
1999-08-01
影响因子：
5.7
通讯作者：
Van Decar, TK
中科院分区：
文献类型：
--
作者：
Herman, NL;Choi, KC;Van Decar, TK
几项研究已经确定了鞘内舒芬太尼用于分娩镇痛的50%和95%有效剂量（分别为ED 50和ED 95）。很少有人研究过这些相同的标准，用于较便宜的替代品芬太尼。此外，鞘内芬太尼在临床相关剂量下的镇痛作用尚不清楚。我们进行了这项研究，以建立剂量-反应关系的鞘内芬太尼镇痛和抑郁症。90名活跃早期分娩（小于或等于5 cm扩张）的产妇以双盲、随机方式接受鞘内芬太尼5、7.5、10、15、20或25 pg（每组n = 15例患者）。在鞘内芬太尼给药后0、1、5、10、15、20、25和30 min，监测产妇的疼痛程度（使用100 mm视觉模拟疼痛量表测量）、血压、动脉血氧饱和度（Sao（2））、呼吸频率、ETCO 2和胎心率。绝对视觉模拟疼痛量表评分小于或等于25 mm被先验定义为镇痛成功。获得镇痛成功的产妇的百分比用于构建量子剂量反应曲线，从中分别推导出总人群（混合产次）和未经产和经产亚群的ED 50和ED 95值。总体ED 50和ED 50值（95% CI）分别为5.5（3.4-7.2）和17.4（13.8-27.1）μ g。不产值（分别为5.3和15.9 μ g）低于多虫值（分别为6.9和26.0 μ g），但在总种群的95%CI内。镇痛成功的产妇瘙痒发生率显示与镇痛相同的剂量-反应关系。ETCO 2显示出剂量相关性增加，特别是在剂量大于或等于15 μ g时，呼吸频率或Sao无伴随变化，这表明潮气量减少。即使在没有明显的嗜睡体征或症状的情况下，鞘内芬太尼在有效镇痛范围内的剂量引起通气的变化，可能持续时间超过我们研究的30分钟。含义：鞘内芬太尼诱导快速和令人满意的剂量依赖性镇痛在早期分娩，但是，它也产生剂量相关的减少通气在没有明显的嗜睡。
Several studies have characterized the 50% and 95% effective doses (ED50 and ED95, respectively) of intrathecal sufentanil for labor analgesia. Few have investigated these same criteria for the less expensive alternative, fentanyl. In addition, the ventilatory effects of intrathecal fentanyl at clinically relevant doses are unclear. We performed this study to establish the dose-response relationship of intrathecal fentanyl for both analgesia and ventilatory depression. Ninety parturients in active early labor (less than or equal to 5 cm dilation) received intrathecal fentanyl 5, 7.5, 10, 15, 20, or 25 pg in a double-blinded, randomized fashion (n = 15 patients in each group). Parturients were monitored for degree of pain (measured using a 100-mm visual analog pain scale), blood pressure, arterial oxygen saturation (Sao(2)) respiratory rate, ETCO2, and fetal heart rate 0, 1, 5, 10, 15, 20, 25, and 30 min after the administration of intrathecal fentanyl. An absolute visual analog pain scale score less than or equal to 25 mm was defined a priori as analgesic success. The percentage of parturients who achieved analgesic success was used to construct quantal dose-response curves, from which the ED50 and ED95 values were derived for the total population (mixed parity) and the nulliparous and multiparous subpopulations separately. Overall ED50 and ED50 values (95% CI) were 5.5 (3.4-7.2) and 17.4 (13.8-27.1) mu g, respectively. Nulliparous values were lower (5.3 and 15.9 mu g, respectively) than multivarous values (6.9 and 26.0 mu g, respectively) but were within the 95% CIs of the total population. Pruritus incidence in parturients with analgesic success displayed a dose-response relationship identical to that seen for analgesia. ETCO2 displayed a dose-related increase, particularly at doses greater than or equal to 15 mu g, without concomitant changes in respiratory rate or Sao, which suggests a decrease in tidal volume. Even in the absence of overt signs or symptoms of somnolence, intrathecal fentanyl at doses within the effective analgesic range induced a change in ventilation that may last longer than the 30-min period we studied. Implications: Intrathecal fentanyl induces rapid and satisfying dose-dependent analgesia in early labor; however, it also produces dose-related decreases in ventilation in the absence of overt somnolence.