Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA.Aims: To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Settings and Design: Prospective, double blind, randomized, comparative study.Materials and Methods: Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 mu g/ml in Group II and with clonidine 1 mu g/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded.Results: At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III.Conclusion: Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1 mu g/kg was superior to fentanyl 2 mu g/ml as an adjuvant in PCEA for labour without any significant feto-maternal adverse effects.

背景：疼痛感受是影响分娩女性感知的最重要的情感决定因素之一。患者自控硬膜外分娩镇痛（PCEA）是一种为此目的而采用的便捷且更安全的技术。过去很少有研究比较可乐定和芬太尼与罗哌卡因在分娩镇痛中的作用。本研究旨在比较PCEA中芬太尼和可乐定的效果。 目的：比较含或不含芬太尼或可乐定的低浓度罗哌卡因用于分娩镇痛及其对母婴安全的影响。 设置与设计：前瞻性、双盲、随机、对照研究。 材料与方法：90名初产妇被分为三组（每组n = 30），并对她们实施患者自控硬膜外分娩镇痛：第一组给予初始推注10ml 0.125%罗哌卡因；第二组给予含2μg/ml芬太尼的罗哌卡因；第三组给予含1μg/kg可乐定的罗哌卡因。随后每组通过患者自控硬膜外镇痛（PCEA）接受0.125%罗哌卡因，背景输注速率为5ml/小时，锁定时间间隔为10分钟，后续推注量为5ml。记录血流动力学参数、感觉平面、运动阻滞和疼痛缓解情况。还记录了局部麻醉剂的总镇痛剂量以及胎儿 - 母体的不良反应。 结果：在基线水平时，各组在人口统计学、血流动力学以及疼痛强度方面具有可比性。所有组的血流动力学参数较基线均有统计学意义的下降，第三组下降幅度最大。在0分钟以及120分钟至240分钟间隔内，视觉模拟评分（VAS）在各组间存在显著差异，第三组数值最低。在分娩方式和娩出努力方面，各组间未观察到显著差异。第一组的总镇痛剂量和PCA推注需求最大，第三组最小，组间差异具有统计学意义。第二组有6名（20%）患者出现寒颤，第三组仅有1名（3.3%）患者出现低血压。 结论：0.125%罗哌卡因在减轻分娩疼痛且无任何运动阻滞方面是有效的。1μg/kg可乐定作为PCEA分娩镇痛的辅助用药优于2μg/ml芬太尼，且无任何显著的胎儿 - 母体不良反应。