An Investigation Of The Efficacy And Safety Of The Combined Spinal Sufentanyl And Epidural Ropivacaine For Labor Analgesia

Objective:(1) To investigate the effect of the combined spinal sufentanyl and epidural ropivaeaine on the procedure of the labor.(2) To observe the efficacy and safety of the combined spinal sufentanyl and epidural ropivacaine for labor analgesia.Methods:In this prospective,40 parturients(ASAⅠ-Ⅱ),gestation＞37 weeks) undergoing labor analgesia were randomly divided into two groups:group S(n=20) received combined spinal-epidural analgesia;group E(n=20) received epidural analgesia.When cervical dilated 3cm,group S received intrathecal sufentanyl 5ug diluted to 2ml.Following insertion of the epidural catheter,a test dose of 0.15% ropivacaine 5ml followed by a priming dose of 0.15% ropivacaine 5ml was administered.The other team,group E received intrathecal 0.9%physiological saline solution 2ml, and after the epidural catheter was placed,a test dose of 0.15%ropivacaine 5ml plus sufentanyl 5ug followed by a priming dose of 0.15%ropivacaine 5ml was administered.A previously programmed PCEA plus background infusion device was connected and started 30 minutes later.The PCEA solution consisted of 0.125%ropivacaine.The background infusion was 6ml/h,and the bolus was 5ml with the lock-out time 15 minutes.If the visual analogue scale(VAS) scores still higher than 3 by 30 minutes after the procedure beginning,0.15%epidural ropivacaine 5ml was given immediately.An investigator,who was blinded to the group assignment,recorded the following data at times 0,5,10,20, 30 and 60 minutes:motor block using the modified Bromage scale,VAS pain score at the peak of the uterine contraction, cephalad level of sensory block,the onset of the analgsia, maternal satisfaction,maternal vital signs and the side effect(nausea,vomiting or pruritus ).Fetal heart rate and uterine contraction were monitored continuously using cardiotocography throughout the study period.Results:Demographic data including high,weight and age were similar between two groups(P＞0.05).Compare to no analgesia,VAS scores were significantly reduced after combined spinal-epidural analgesia in both group. Parturients were satisfied.In this study,we found the onset of analgesia in the group S was significantly shorter than the group E(P＜0.01).No motor block occurred during the study.There was no significant difference in duration of the stages of labor, oxytocin consumption,fetal apgar scores(P＞0.05).In group S,the blood pressure was slight decreased at the point of 5minutes and 10 minutes(P＜0.05).There was no statistical difference in maternal heart rate(P＞0.05).The incidence of pruritus was significantly higher in group S than in group E(P＜0.01).But the pruritus was very slight,and there was no necessary to treat.One Parturients per team selected cesarean birth because of dystocia such as larger baby during the study.There was no relationship between cesarean and labor analgesia in this study.Conclusions:combined spinal sufentanyl and epidural ropivacaine provides rapid,satisfied and safe labor analgesia.There is slight pruritus during the labor.