関連する実験動画
出産の進行に対する外経対親経オピオイド鎮痛薬の効果:メタ解析
S H Halpern1, B L Leighton, A Ohlsson
1Department of Anaesthesia, University of Toronto and Women's College Hospital, Ontario, Canada. halpern@ftn.net
JAMA
|January 6, 1999
まとめ
エピデュラル分娩鎮痛は,帝王切開による出産率を増加させない. 出産時間が長くなるかもしれませんが,外周麻酔は,親経オピオイドと比較して患者の満足度と新生児のアウトカムを改善します.
科学分野:
- 産婦人科と産婦人科を担当しています.
- アネステシオロジー アネステシオロジー
- 産周医学は,産周医学である.
背景:
- エピデュラル分娩鎮痛は,しばしば高い帝王切開出産率と関連しています.
- 以前の臨床試験では, epidural anesthesiaとparenteral opioidsを比較したところ,帝王切開による出産率に関して矛盾した結果が出ていた.
研究 の 目的:
- 帝王切開の出産率に対する外注経口対親体経口オピオイド鎮痛薬の効果を体系的にレビューし,比較する.
- 異なる分娩鎮痛方法が分娩期間,出産方法,母親の満足度,新生児の成績に与える影響を評価する.
主な方法:
- 1966年から1998年まで,複数のデータベース (MEDLINE,Cochrane Database of Perinatal Trials) で包括的な文献検索が行われました.
- 2369人の患者が参加した10件のランダム化試験が含まれており,出産中に epidural analgesiaとparenteral opioid analgesiaを比較した.
- データは2人の独立したレビュー者によって抽出され,ランダム効果モデルを使用して分析を行い,オッズ比率と95%信頼区間で加重平均差を計算しました.
主要な成果:
- 帝王切開の出産率は, epidural (8.2%) と parenteral opioid (5.6%) グループ (OR, 1.5; 95% CI, 0.81-2.76) の間で有意に異なっていなかった.
- エピデュラル鎮痛は,第1期と第2期の出産期間が長くなったが,ダイストシアの器具配達が増加したとは関係なかった.
- epidural analgesiaを受けた患者は,痛みのスコアが著しく低下し,満足度が高く,新生児のアウトカムが改善されたと報告しました (Apgarスコアが低く,ナロキソンへの需要が少なく).
結論:
- エピデュラル分娩鎮痛は,帝王切開の出産率やダイストシアの器具出産率の上昇と関連していません.
- エピデュラルの使用で出産期間が増加するかもしれませんが,親経オピオイドと比較して,痛みを和らげる,母親の満足度,新生児の健康という点で大きな利点があります.
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