Comparison Of Efficacy Of Intravenous Infusion Of Nalbuphine And Remifentanil As Adjuvant To Epidural Labor Analgesia

Objective: To compare the clinical efficacy and safety of intravenous nalbuphine and remifentanil combined with epidural block in labor analgesia.Methods: A total of 150 full-term parturient women were randomly divided into3 groups with 50 patients in each group: simple epidural analgesia group(group C),nalbuphine combined with epidural analgesia group(group N)and remifentanil combined with epidural analgesia group(group R),with 50 patients in each group.In group C,epidural labor arrest and analgesia were performed when the uterine orifice was opened to 3cm.N group received intravenous injection of nalbuphine 0.1mg/kg10 minutes before epidural puncture.In group R,the first dose of remifentanil was given intravenously within 0.2ug/kg 10 minutes before epidural puncture,and at the same time,the infusion dose of remifentanil was given intravenously with a dose of0.05μg/(kg·min).The infusion of remifentanil was stopped when the anesthesia level reached T10.All three groups were given 0.065% ropivacaine +0.4ug/ml sufentanil epidural continuous pumping.Visual analogue scale(VAS)scores were recorded before analgesia,immediately after epidural puncture and after analgesia.The duration of labor,the rate of cesarean section,the rate of instrumental-assisted labor,the utilization rate of oxytocin and the maternal satisfaction were recorded.Apgar scores(1min,5min,10min)of neonates were recorded,and umbilical artery blood was extracted for blood gas analysis.Observe the adverse reactions during delivery.RESULTS: Compared with group C,immediate VAS score of epidural puncture in group N and R was significantly decreased,with statistical significance(P<0.05).The immediate VAS score of epidural puncture in R group was lower than that in N group,but the difference was not statistically significant(P >0.05).Compared with group C,immediate Ramsay sedation score of epidural puncture in group N and R was increased,and the difference was statistically significant(P < 0.05).The immediate Ramsay sedation score of epidural analgesia in group R was higher than that in group N,with statistical significance(P <0.05).Compared with group C,the incidence of dizziness was increased in group N and R,and the difference was statistically significant(P < 0.05),but there was no difference between group N and R(P > 0.05).Compared with N and C groups,the incidence of somnolence in R group was increased,and the difference was statistically significant(P < 0.05),but there was no difference between N and C group(P > 0.05).The maternal satisfaction score of N and R group was higher than that of C group,the difference was statistically significant(P < 0.05),but there was no difference between N and R group(P >0.05).There were no significant differences in VAS score at other time points,labor duration,cesarean section rate,instrument assisted delivery rate,oxytocin utilization rate,Apgar score of newborn and umbilical artery blood gas analysis among the three groups(P>0.05).Conclusion: Intravenous infusion of small doses of nalbuphine and remifentanil can significantly relieve the pain before the epidural labor analgesia,relieve the tension of the pregnant women,so that it can better cooperate with the anesthesiologist’s instructions,create more favorable conditions for the anesthesia operation,reduce the occurrence of anesthesia complications,and improve the satisfaction of the pregnant women.At the same time does not affect the delivery mode,do not prolong the labor process,do not increase the occurrence of serious adverse reactions of maternal and infant.