Comparison of PCIA with tramadol and combined spinal-epidural analgesia +PCEA with ropivacaine and fentanyl for labor analgesia
- VernacularTitle:曲马多静脉PCA与腰麻-硬膜外联合麻醉后病人自控镇痛用于分娩镇痛的比较
- Author:
Jianjing LONG
;
Yun YUE
- Publication Type:Journal Article
- Keywords:
Tramadol;
Injections, intravenous;
Analgesia, obstetrical;
Analgesia, epidural;
Analgesia, patient-controlled
- From:
Chinese Journal of Anesthesiology
1995;0(02):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the analgesic efficacy and safety of patient controlled intravenous analgesia (PCIA) with tramadol for labor analgesia as compared with combined spinal-epidural analgesia (CSEA) + patient controlled analgesia (PCEA) with ropivacaine and fentanyl. Methods Eighty ASA Ⅰ - Ⅱ full term primigravidae in active labor (at 2 ～ cm cervical dilation) who had a single fetus with vertex presentation and were expected to have a vaginal delivery were randomly divided into 3 groups: 1 control group received no analgesia ( n = 30), Ⅱ group A received CSEA + PCEA with ropivacaine and fentanyl ( n = 30) and Ⅲ group B received PCIA with tramadol (n = 20) . In group A CSEA was performed at L2-3. Ropivacaine 2.5 mg and fentanyl 5 mg were injected intrathecally. A catheter was then advanced 4 cm into epidural space cephalad for PCEA with a mixture of 0.1% ropivacaine with fentanyl 5?g?ml-1 (background infusion 4 ml?h-1 , demand bolus 4 ml with a 15 min lockout interval). In group B the loading dose of tramadol was 1 mg?kg-1 followed by background infusion of 0.75% tramadol at a rate of 2 ml?h-1 (demand bolus 2 ml with a 10 min lockout interval and a total dose limit of 500 mg) . The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified Bromage score. The vital signs (BP, HR, SpO2), fetal heart rate, labor process, mode of delivery, Apgar score of neonates and side effects of analgesia were recorded. Results Good analgesia was achieved with high patient satisfaction in group A (96.7%) and B (95%) as compared with control group, but there was no significant difference in VAS score between group A and B. The onset time of analgesia was significantly shorter in group A (2.4 ? 1.2) min than that in group B (5.3 ? 2.7) min ( P
