低剂量右美托咪定鼻内给药可改善硬膜外分娩镇痛效果并减轻硬膜外穿刺过程中的疼痛：一项前瞻性随机双盲临床研究

以下文章来源于罂粟花，作者anesthGH

本文由“罂粟花”授权转载

低剂量右美托咪定鼻内给药可改善硬膜外分娩镇痛效果并减轻硬膜外穿刺过程中的疼痛：一项前瞻性随机双盲临床研究

贵州医科大 麻醉与心脏电生理课题组

翻译：张中伟  

编辑：柏雪  

审校：曹莹

目的:

硬膜外分娩镇痛是一种安全有效的分娩镇痛管理方法，但硬膜外穿刺存在起效时间长和穿刺过程中产妇痛苦等缺点。本研究旨在评估鼻内低剂量右美托咪定给药是否能有效缩短镇痛起效时间并减少穿刺疼痛。  

方法：

在这项前瞻性随机双盲试验中，产妇被随机分为右美托咪定组和对照组。右美托咪定组鼻内给药0.5μg/kg，对照组鼻内给予等量生理盐水。两组均采用程序性间歇性硬膜外推注维持。主要观察指标是镇痛的起效时间和硬膜外穿刺过程中相关的疼痛评分。  

结果：

本研究纳入79名患者，60名患者完成了研究并纳入分析。右美托咪定组镇痛起效的时间明显短于对照组（危险比=2.069；95%可信区间2.187~3.606；P=0.010）。右美托咪定组硬膜外穿刺过程中视觉模拟量表疼痛评分也明显低于对照组（2.0[1.8-2.5] vs 3.5[3.3-4.5]，P≤0.001，表2）。硬膜外分娩镇痛前鼻内右美托咪定预处理可改善视觉模拟量表疼痛评分和Ramsay评分，减少镇痛药用量，提高产妇满意度（P<0.05）。两组产妇和新生儿的不良反应发生率无差异。  

结论：

硬膜外分娩镇痛前鼻内右美托咪定给药可缩短镇痛起效时间，并减少硬膜外穿刺过程中的疼痛，而不会增加不良反应。右美托咪定鼻内预处理可能是硬膜外镇痛的一种有效辅助手段，应鼓励进一步研究以更充分地确定其效用。

原始文献来源:

Hao Sun, Xiang Ma, Shengyou Wang,et al.Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study.[J]. BMC Anesthesiology (2023) 23:185

英文原文：

Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study

Abstract  

Background Epidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain.  

Methods In this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/ kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture.  

Results Seventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 [1.8–2.5] vs. 3.5 [3.3–4.5], P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups.  

Conclusions Pretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully.  

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱

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