Minimum local analgesic concentration of Ropivacaine combined with Hydromorphone for epidural labor analgesia during incubation period using sequential allocation method#br#
WANG Kegong WANG Haijin ZHANG Zhen LUO Huiyu
Department of Anesthesiology, Xiangyang NO.1 People’s Hospital, Affiliated Hospital of Hubei University of Medicine, Hubei Province, Xiangyang 441000, China
Abstract:Objective To determine the minimum local analgesic concentration (MLAC) and 90% effective concentration (EC90) of Ropivacaine combined with Hydromorphone for epidural labor analgesia during latent period. Methods Thirty cases of singleton primiparous admitted to Xiangyang NO.1 People’s Hospital, Affiliated Hospital of Hubei University of Medicine from June 2019 to January 2020 were selected as study objects. All parturients entered the incubation period of the first stage of labor, L2-3 was selected for epidural labor analgesia, and 10 ml of Ropivacaine mixed with 15 μg/ml Hydromorphone was given. According to the modified sequential allocation method to increase or decrease the concentration of Ropivacaine, the initial concentration was 0.07%, the concentration gradient was 0.01%. Visual analogue scale (VAS) was used to evaluate the analgesia effect. If VAS score ≤3 points, the next patient was reduced a concentration gradient; if VAS score >3 points, after giving 6 ml of dose 0.1% Ropivacaine mixed with 0.5 μg/ml Sufentanil to remedy and VAS score≤3 points, the following one patient was increased a concentration gradient; if after giving remedy drugs and VAS score >3 points, this case was eliminated, and the next patient was repeated this concentration. VAS score during contractions were recorded before injection, 5, 15, and 30 min after injection. MLAC and EC90 of Ropivacaine were calculated by probability unit regression analysis. Results MLAC of Ropivacaine combined with Hydromorphone for epidural labor analgesia in incubation period was 0.035%, and EC90 was 0.049%. Conclusion MLAC of Ropivacaine combined with Hydromorphone for epidural labor analgesia in incubation period is 0.035%, and EC90 is 0.049%, it can be safely used for epidural labor analgesia with fast analgesic effect and few adverse reactions.
王克功 汪海金 张振 罗辉宇. 序贯法测定氢吗啡酮用于潜伏期硬膜外分娩镇痛罗哌卡因最低有效浓度[J]. 中国医药导报, 2021, 18(31): 119-122.
WANG Kegong WANG Haijin ZHANG Zhen LUO Huiyu. Minimum local analgesic concentration of Ropivacaine combined with Hydromorphone for epidural labor analgesia during incubation period using sequential allocation method#br#. 中国医药导报, 2021, 18(31): 119-122.
[1] 黄遐,杨娟.分娩镇痛研究进展[J].国际妇产科学杂志,2017,44(2):197-201.
[2] 中华医学会麻醉学分会产科学组.分娩镇痛专家共识(2016版)[J].临床麻醉学杂志,2016,32(8):816-818.
[3] 林雷,陈春,柯齐斌,等.氢吗啡酮对硬膜外阻滞分娩镇痛时布比卡因最低有效浓度的影响[J].重庆医学,2015, 44(6):772-774.
[4] 卢园园,黄璜,毛卫亮,等.氢吗啡酮复合罗哌卡因用于分娩镇痛的量效研究[J].中华医学杂志,2017,97(42):3297-3300.
[5] Guasch E,Iannuccelli F,Brogly N,et al. Failed epidural for labor:what now?[J]. Minerva Anestesiol,2017,83(11):1207-1213.
[6] O’Reilly-Shah V,Lynde GC. Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method [J]. BMC Anesthesiol,2018,18(1):140.
[7] Zhou X,Li J,Deng S,et al. Ropivacaine at different concentrations on intrapartum fever,IL-6 and TNF-α in parturient with epidural labor analgesia [J]. Exp Ther Med,2019,3(17):1631-1636.
[8] Sviggum HP,Arendt KW,Jacob AK,et al. Intrathecal Hydromorphone and Morphine for Postcesarean Delivery Analgesia:Determination of the ED90 Using a Sequential Allocation Biased-Coin Method [J]. Anesth Analg,2016, 123(3):690-697.
[9] 中华医学会麻醉学分会.成人手术后疼痛处理专家共识[J].临床麻醉学杂志,2017,33(9):911-917.
[10] 谭瑛,梁曼,张贻岚,等.不同浓度罗哌卡因联合舒芬太尼应用于硬膜外分娩镇痛的效果分析[J].中国现代手术学杂志,2018,22(4):311-315.
[11] 王菲菲,郑丽宏.盐酸氢吗啡酮在麻醉中的应用研究进展[J].医学综述,2017,23(3):528-531.
[12] 李丹,陈琦,康宇,等.硬膜外腔注射氢吗啡酮在剖宫产术后镇痛的临床观察[J].国际麻醉学与复苏杂志,2016, 37(4):310-312.
[13] 罗冠贤.盐酸氢吗啡酮的临床研究进展[J].医学理论与实践,2016,29(10):1289-1291.
[14] Mhyre JM,Hong RW,Greenfield ML,et al. The median local analgesic dose of intrathecal bupivacaine with hydromorphone for labour:a double-blind randomized controlled trial [J]. Can J Anaesth,2013,60(11):1061-1069.
[15] 陈伟强,郑春勤,曹铭辉.吗啡与氢吗啡酮在硬膜外自控镇痛的比较:meta分析[J].岭南现代临床外科,2019, 4(19):451-454.
[16] 张素素,毛毛,李彩娟,等.改良序贯法测定氢吗啡酮用于潜伏期硬膜外分娩镇痛的半数有效剂量[J].临床麻醉学杂志,2020,36(6):552-554.
[17] Marroquin B,Feng C,Balofsky A,et al. Neuraxial opioids for post-cesarean delivery analgesia:can hydromorphone replace morphine? A retrospective study [J]. Int J Obstet Anesth,2017,30:16-22.
[18] 石波,张薇薇,简文亭.盐酸氢吗啡酮复合布比卡因在腰硬联合阻滞剖宫产术中的应用[J].实用医学杂志,2016, 32(3):469-471.
[19] Felden L,Walter C,Harder S,et al. Comparative clinical effects of hydromorphone and morphine:a meta-analysis [J]. Br J Anaesth,2011,107(3):319-328.
[20] 杨文婧,徐源,初丽艳,等.腘窝坐骨神经阻滞术中合用盐酸氢吗啡酮对罗哌卡因镇痛时效的影响[J].临床和实验医学杂志,2018,17(9):976-979.
[21] Guo S,Li B,Gao C,et al. Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor:A Meta-Analysis [J]. Medicine(Baltimore),2015,94(23):e880.
[22] Costa-Martins JM,Dias CC,Pereira M,et al. Effects of local anesthetic on the time between analgesic boluses and the duration of labor in patient-controlled epidural analgesia:prospective study of two ultra-low dose regimens of ropivacaine and sufentanil [J]. Acta Med Port,2015,28(1):70-76.
[23] 李冰,陈绪军,郭艳,等.不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用[J].临床麻醉学杂志,2016,32(4):361-365.
[24] 万丽,赵晴,陈军,等.疼痛评估量表应用的中国专家共识(2020版)[J].中华疼痛学杂志,2020,16(3):177-187.
[25] 罗妙妙,陈新忠,祝胜美.不同浓度氢吗啡酮对罗哌卡因硬膜外分娩镇痛效应的影晌[J].中国新药与临床杂志,2019,38(12):734-738.
[26] Puhto T,Kokki M,Hakom?覿ki H,et al. Single dose epidural hydromorphone in labour pain:maternal pharmacokinetics and neonatal exposure [J]. Eur J Clin Pharmacol,2020,76(7):969-977.
[27] 王雅端,孙加晓,颜景佳.氢吗啡酮联合罗哌卡因用于分娩镇痛的效果观察[J].中国微创外科杂志,2019,19(9):778-781.