- 期刊
The Efficacy of Intrathecal Coadministration of Morphine and Bupivacaine for Labor Analgesia
經脊髓腔合併注射嗎啡及麻可因行無痛分娩之效果
摘要
Background: Intrathecal (IT) opioids can provide labor analgesia, but the onset of pain relief is slow. Bupivacaine has the beneficial property of less motor blockade than other local anestheties. This study retrospectively examined the efficacy of concomitant use of IT morphine and bupivacaine for labor pain relief. Methods: Fifty five nulliparas who requested analgesia in the active phase (IA group) prior to a cervical dilation 3.9±0.6 cm and received IT morphine 0.5 mg and 0.1% bupivacaine 2.5 mag served as the treatment group, and 88 similar nulliparas who did not request and receive analgesia served as the control group. Results：The mean onset time of analgesia was 2.6±0.5 min, the duration was 4-12 h and 93% of parturients did not request additional analgesia after a single injection of IT morphine and bupivacaine. The active phase of the first and second stages of labor in the treatment group were significantly longer [318 ± 214 min vs. 176 ± 120 min; 74 ± 29 min vs. 37 ± 26 min]. Frequency of instrument-assisted vaginal delivery was higher compared with the control group (30.9% vs. 14.1%). However，there were no significant differences in the rate of cesarean section and the Apgar scores of newborns at I min and 5 min between the treatment and control group. The major side effects of the treatment group included pruritus (48%), nausea (40%), vomiting (37%), somnolence (27%), shivering (27%), urinary retention (21%), hypotension (15%), and bradycardia (13%). Most of the side effects were mild and could be alleviated by naloxone. Neither post-spinal headache nor respiratory depression was noted. Conclusions: Our results showed that a single injection of IT morphine and bupivacaine provided rapid onset and effective analgesia with manageable side effects and without major complications. Thus, IT morphine and bupivacaine provides an alternative to epidural analgesia for most women in labor.
並列摘要
背景：雖然以硬膜外麻醉可有效地緩解產痛，但仍未被廣泛使用，特別在缺乏麻醉設備及人力之醫院或診所。近來國外報告顥示，以嗎啡注射於脊髓腔（IT）也可獲得有效的產程止痛、但仍伴有作用時間太慢的缺點。低劑量與低濃度IT麻可因應可加快作用，且理論上有協助作用於嗎啡、及較少運動神經之抑制。本研究評估以IT併用嗎啡和麻可因來行無痛分娩之結果與影響。方法：在台灣省立朴子醫院八個月期間、共有55位足月、單胎、頭位之初產婦在第一產程活動期要求止痛、其先於硬膜外放置一18G導管但不給藥、之後再以27G脊髓針給予IT嗎啡0.5mg和麻可因2.5mg（稀釋2.5ml）行無痛分娩、而同期間有88位相同情況之初產婦且未要求止痛者為對照組。結果：IT組之止痛作用時間為4－12小時、起始時間為2.6 ± 0.5分、而有93%產婦於IT單次注射後未再要求止痛；IT組之第一產程活動期與第二產程皆有延長、且經陰道器械輔助生之比例較高；但剖腹產之比例及嬰兒之Apgar Score則兩組沒有顯著差異。IT組副作用之發生率為搔癢（48%）、噁心（40%）、嘔吐（37%）、嗜睡（27%）、尿滯留（21%）發抖（27%）、血壓降低（15%）、和徐脈（13%）、其程度大多屬輕微且可以naloxone減緩或48小時內自行消退。結論：單次脊髓腔注射嗎啡0.5mg併用0.1%麻可因2.5mg雖伴有副作用、但可快速、經濟且有效地緩解大部份產婦之產痛。為使無痛分娩更被廣泛使用、我們的方法對於麻醉人力與設備較缺乏之醫院可提供硬膜外無痛分娩的另一種選擇。
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