产痛后带止痛剂度与编程间歇性外周螺栓:一个前性观察性研究
Arisa Ijuin1, Masaki Sato1, Nagayoshi Umehara2
1Division of Obstetric Anesthesiology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
概括
罗皮瓦卡因和芬太尼的带度在新生儿中较低,这些新生儿的母亲因分娩疼痛而接受了编程间歇性外周止痛 (PIEB) 和患者控制的外周止痛疗法 (PCEA). 这种间歇性玻尿酸治疗方案可能会减少胎儿对止痛药的暴露.
科学领域:
- 产科和妇科 产科和妇科
- 麻醉学 麻醉学
- 新生儿医学 新生儿医学
背景情况:
- 外周止痛在分娩过程中很常见,但胎儿接触止痛药是令人担忧的.
- 编程间歇性外围注射 (PIEB) 和患者控制的外围注射止痛 (PCEA) 是连续输注的替代方案.
- 在PIEB和PCEA中使用的止痛药的带度没有得到很好的描述.
研究的目的:
- 测量罗皮瓦卡因和芬太尼的带静脉度.
- 评估这些度对新生儿在分娩时的状况的影响.
- 为了比较PIEB和PCEA疗程之间的止痛度.
主要方法:
- 一项针对50名分娩者进行的前性研究,这些分娩者接受了与PIEB和PCEA结合的脊柱外皮止痛疗法.
- 止痛疗法包括0.08%的罗皮瓦卡因和2μg·mL-1芬太尼.
- 对带静脉样本进行了罗皮瓦卡因和芬太尼度分析;记录了新生儿的特征.
主要成果:
- 罗皮瓦卡因和芬太尼的平均每小时剂量分别为13 mg·hr-1和39 μg·hr-1.
- 产后带静脉度的中位数为罗皮瓦卡因的77 ng·mL−1和芬太尼的0.125 ng·mL−1.
- 所有新生儿的动脉pH值和Apgar评分都正常;没有观察到系统局部麻醉毒性.
结论:
- 使用PIEB和PCEA进行分娩止痛,导致带止痛剂度低.
- 间歇性玻尿酸外注方案可能会减少胎儿对止痛药的暴露.
- 研究的治疗方案与有利的新生儿结局有关.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
421
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
421
Local Anesthetics: Clinical Application as Spinal Anesthesia
591
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
591
Opioid Analgesics: Synthetic and Semisynthetic Opioids
239
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
239
Analgesia and Pain Management
547
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
547
Parenteral Anesthetics: Overview
107
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
107
Local Anesthetics: Differential Sensitivity of Nerve Fibers
790
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
790


