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World Journal of Clinical Cases 2021年第8期9卷 1946-1952页

作者： Lin-Lin Song Yin Zhou Zhi-Yu Geng Department of Anesthesiology Peking University First HospitalBeijing 100034China

BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

关键词： epidural analgesia Hydroxyethyl starch Accidental dural puncture Postdural puncture headache Prophylaxis Case report

Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor： a randomized clinical trial

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Chinese Medical Journal 2010年第2期123卷 178-183页

作者： WANG Li-zhong CHANG Xiang-yang LIU Xia HU Xiao-xia TANG Bei-lei Department of Anesthesiology Jiaxing Maternity and Child Care Hospital Jiaxing Zhejiang 314001 China Department of Obstetrics Jiaxing Maternity and Child Care Hospital Jiaxing Zhejiang 314001 China

Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine （Group B）, ropivacaine （Group R） or levobupivacaine （Group L） with sufentanil 0.5 ug/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was 〈30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction （P 〉0.05）. The relative median potency was bupivacaine/ropivacaine： 0.828 （0.602-1.091）, bupivacaine/levobupivacaine： 0.845 （0.617-1.12）, ropivacaine/levobupivacaine： 1.021 （0.774-1.354）, respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of 〉0.1% within each group （P 〈0.05）. Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with s＇ufentanil produce similar analgesia and motor block and safe

关键词： labor epidural analgesia bupivacaine ropivacaine levobupivacaine Background

Clinical Study of epidural analgesia with Clonidine andSumatriptan in Posthysterectomy

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1997年第3期17卷 172-176页

作者：刘志恒田玉科张传汉金士翱 Department of Anaesthesiology Tongji Hospital Tongji Medical University Wuhan

A clinical study was conducted to compare the analgestic effect of clonidine with those of sumatriptan and their mixture and their effects on hemodynamics. 40 patients undergoing elective total hysterectomy were randomly divided into 4 groups in terms of the epidurally administered drugs with 10 patients in each group (group C1: clonidine 150 μg, group C2: clonidine 75 μg, group S: sumatriptan 6 mg and group S+C:clonidine 75 μg + sumatriptan 3 mg). MAP, HR,SpO2, VT VAS, VRS and ePDT were measured in the initial 4 h. The demographic data and the doses of intraoperative local anesthetics among the 4 groups were not staistically different. It was found that no significant difference in the pre- and postadministration values of HR, SpO2 and VT. A obvious reduction of MAP appeared in the groups of C1 and C2, but in the other groups the hemodynamical parameters were stable. The groups of C1, C2 and S+C showed significant increase in VAS and VRS, along with increase of ePDT when comapred with the pre-drug level. There was no obvious alteration in group S after the drug administration. It was concluded that (1) single use of sumatriptan is ineffective in the dose given in this study; (2) small dose (150 μg and 75μg) of clonidine has epidurally analgesic effects; (3) combined use of sumatriptan and clonidine is an acceptable way in epidural analgesia, in terms of its analgesic effect and hemodynamic changes.

关键词： epidural analgesia clonidine sumatriptan

A systematic Review of the Safety and Effectiveness of epidural analgesia for Labor analgesia

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Asian Journal of Social Pharmacy 2022年第2期17卷 186-197页

作者： Wang Dan Liu Chunping Zhang Fang Gao jinglei School of Business Administration Shenyang Pharmaceutical UniversityShenyang 110016China China National Health Development Research Center Beijing 100000China

Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.

关键词： epidural analgesia opioid intravenous analgesia non-epidural analgesia acupuncture stimulation inhalation analgesia continuous care labor analgesia systematic review re-evaluation

epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

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Chinese Medical Journal 2023年第1期136卷 88-95页

作者： Yin Zhou Zhiyu Geng Linlin Song Dongxin Wang Department of Anesthesiology Peking University First HospitalBeijing 100034 China

Background:No convincing modalities have been shown to completely prevent postdural puncture headache(PDPH)after accidental dural puncture(ADP)during obstetric epidural procedures.We aimed to evaluate the role of epidural administration of hydroxyethyl starch(HES)in preventing PDPH following ADP,regarding the prophylactic efficacy and side effects.Methods:Between January 2019 and February 2021,patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital.The development of PDPH,severity and duration of headache,adverse events associated with prophylactic strategies,and hospital length of stay postpartum were reported.Results:A total of 105 patients experiencing ADP received a re-sited epidural catheter.For PDPH prophylaxis,46 patients solely received epidural analgesia,25 patients were administered epidural HES on epidural analgesia,and 34 patients received two doses of epidural HES on and after epidural analgesia,respectively.A significant difference was observed in the incidence of PDPH across the groups(epidural analgesia alone,31[67.4%];HES-epidural analgesia,ten[40.0%];HES-epidural analgesia-HES,five[14.7%];Pepidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP(OR=0.030,95%confidence interval:0.006-0.143;Pepidural catheter with continuous epidural analgesia and two doses of epidural HES,respectively,on and after epidural analgesi

关键词： Accidental dural puncture epidural analgesia Hydroxyethyl starch Postdural puncture headache Prophylaxis

The Outcome Analysis of epidural analgesia on Labor in Primigravida Women:a Systematic Review and Meta-analysis Focusing on Duration of Labor

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The Outcome Analysis of Epidural Analgesia on Labor in Primi...

作者： Angela Peter Aweda 重庆医科大学

学位级别：硕士

BACKGROUND: epidural anesthesia is extensively used worldwide for pain relief in labor and more lately as an alternative and preferred form of anesthesia for caesarean sections;although its use is gaining universality,its outcome on the duration of labor is still debatable.Our meta-analysis aimed at analyzing the effects of epidural analgesia on duration of labor in primigravid women focusing on duration of labor.METHODS: We conducted a systematical literature search in Pub Med and Embase(from the inception to July 2016).We calculated weighted mean differences(WMD)between the groups for continuous data,and corresponding 95% confidence intervals(CIs)using the random-effects model.We also performed a subgroup analysis for the effects of different types of studies on duration of labor.Statistical heterogeneity amongst the included studies was tested by I2 indicator.RESULTS: Twelve studies,recruiting 16200 mothers overall,were selected for this systematic review and meta-analysis.The duration of first stage of labor was significantly prolonged in the no epidural group by a mean of 2.66(0.89,4.43,P=0.003)and significantly shortened the second stage of labor by a mean of-12.79(-21.13,-4.45,P=0.003).Moreover,the overall subgroup analyses shown significantly prolongation of the first stage of labor by the same mean of 2.66(0.89,4.43,P=0.003).CONCLUSION: The use of epidural analgesia for pain relief during labor is not associated with prolongation of first and second stages of labor in the groups of patients who requested epidural analgesia for pain relief during normal vaginal delivery.

关键词： epidural analgesia Labor Primigravid Ropivacaine

Comparison of Intra-articular and epidural analgesia by Morphine after Arthroscopic Knee Surgery:A Meta-Analysis

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Comparison of Intra-articular and Epidural Analgesia by Morp...

Women’s Awareness and Attitudes towards Labor analgesia Influencing Practice between Developed and Developing Countries

2012年浙江省骨科学术年会

作者： Lin Tiao Yan Shi-gui Wang Cong Department of Orthopedics Surgery Second Affiliated Hospital School of Medicine Zhejiang University

Objective To compare the effect and side effect of intra-articular and epidural analgesia by morphine after arthroscopic knee surgery. Methods A literature search was conducted by using electronic database. Further searches for articles were conducted by checking all references describing intra-articular and epidural analgesia after arthroscopic knee operation. From the included studies, methodological qualities were assessed and data were extracted according to Cochrane Handbook 5.1. The relevant data of the homogeneous studies were pooled using RevMan 5.1 software. Results Five Randomized controlled trials (RCTs) involving 289 patients met the inclusion criteria. The results of meta-analysis showed that 8 hours after operation, the Visual analogue score (VAS) in the group of intra-articular (IA) was significantly lower than the group of epidural (IE) [WMD= -0.18, 95%CI(-0. 34,-0.01), P=0.0 4]. However, no differences between the VAS of the IA group and the IE group were observed 24 hours post surgery [WMD= -0.25, 95%CI(-0.58,0.08), P=0.13]. Side effects:The IA group obviously reduced more incidences of adverse events than IE group:[nausea and vomiting, OR= 0. 11, 95%CI (0.02, 0.48), P=0.0003;pruritus, OR= 0.08, 95%CI (0.02, 0.33), P=0. 0005;urinary retention, OR= 0.06, 95%CI (0.01, 0.24), Panalgesia by morphine after arthroscopic knee surgery had a more effective in acute pain relief, and the IA analgesia avoided more incidences of side effects than IE analgesia.

关键词： Morphine Intra-articular analgesia epidural analgesia Arthroscopic knee surgery

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Advances in Reproductive Sciences 2016年第2期4卷 46-52页

作者： Shammi Karn Hong Yu Sourabh Karna Liqin Chen Dongyan Qiao Department of Obstetrics and Gynecology Zhong Da Hospital Medical School Southeast University Nanjing China Nepal Medical College Kathmandu University Kathmandu Nepal

Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more women become aware of their rights to achieve a better quality of care during labor. There are various non-pharmacologic (transcutaneous electrical nerve stimulation, hydrotherapy, intradermal water injections and acupuncture) and pharmacologic treatments (nitrous oxide, opioids and regional analgesia techniques: spinal, epidural and combined epidural analgesia) available today. Among these, epidural analgesia offers the most effective form of pain relief and is considered to be the gold standard of labor analgesia. Despite having labor analgesic services, most women still go through painful labor due to lack of knowledge regarding it, particularly in developing countries. The main source of information regarding pain reliefs is from friends and relatives, revealing the lack of information from caregiver’s side. So this study reflects that there is a wide gap in the communication between pregnant women and obstetricians. It supports the fact that obstetricians through the practice of routinely offering labor analgesia can significantly improve the maternal and perinatal outcomes of pregnancy. Provision of standardized epidural analgesia information at an appropriate time in their pregnancy may benefit them by the practice of mutual decision-making. Thus, it may prevent women from making a difficult choice of cesarean section to avoid the fear of painful labor.

关键词： Pain Relief epidural analgesia Labor analgesia Developing Country Developed Country Labor Pain

The Effect of General Anesthesia Combined with epidural Anesthesia and PCEA on the Early Postoperative Cognitive Function in Elderly Patients

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The Effect of General Anesthesia Combined with Epidural Anes...

中国中西医结合麻醉学会[CSIA]年会暨第二届全国中西...

作者： Yu Chen Yanqing Chen Department of Anesthesiology Fujian Provincial Hospital

Background:Postoperative cognitive dysfunction(POCD) is a common neurological complication among the elderly after major surgery.POCD are marked by deficits of cognitive and memory,comprise a wide range of disorders from neurocognitive,and will resulting in significant long-term morbidity and an overall reduced quality of life.As yet,the etiology of POCD is still unclearly,an association between POCD and the anesthetic methods has been suspected.In this study,we assessed if general anesthesia combined with epidural anesthesia + PCIA can reduce the incidence of POCD among the elderly patients that aged over 65 who underwent open radical gastrectomy(ORG).Methods:90 ASA Ⅰgrade elderly patients that aged over 65 who underwent ORG from March 2014 to January 2015 were recruited in the study.According to the table of random number,the patients were into three groups:individual general anesthesia + PCIA(Group A),general anesthesia combined with epidural anesthesia + PCIA(Group B) and general anesthesia combined with epidural anesthesia + PCEA(Group C).0.375%ropivacaine were administered epidural in Group B and Group C.Cognitive function was assessed1 d before operation and on the 6 h,12 h,2d,3d and 5 d after operation,by the Mini-Mental State Examination test(MMSE).HR and MAP were recorded during the different peri-operative periods,i.e.10 min before induction of anesthesia(TO),1 h after skin incision(T1),1 min after abdominal closure(T2),and the moment of extubation(T3).Blood samples were collected from the central venous to detect the concentrations of serum protein S-100 P > NSE by ELISA before induction and 24 h postoperative.Results:There were no significant differences in age,sex,ASA grade,BMI,operation duration and pre-operative cognitive function among three groups.Incidents of POCD:at 6 h and 12 h after operation,Group C was lower than Group A and Group B.On 2 d postoperation,Group C was lower than Group A.On 3d and 5 d postoperation,Group B and Group C were lower than Group A.Group A had a greater change in hem

关键词： epidural block epidural analgesia Elderly patients Postoperative cognitive function

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“1-2-1”混合液在硬脊膜外腔的扩散

临床麻醉学杂志 1986年第4期 204-207页

作者：张国楼刘华庄蟾芬方琰林建梁萍惠宁宁南京医学院一附院麻醉科

应用“1-2-1”混合液（1％地卡因1份,2％利多卡因2份,生理盐水1份,含肾上腺素1/200,000）进行硬膜外麻醉118例。分别选择T9-10和L2-3椎间隙为穿刺注药点,系统地观察了最大阻滞平面并计算出阻滞每对背神经所用局麻药液的容量（节段剂量... 详细信息

应用“1-2-1”混合液（1％地卡因1份,2％利多卡因2份,生理盐水1份,含肾上腺素1/200,000）进行硬膜外麻醉118例。分别选择T9-10和L2-3椎间隙为穿刺注药点,系统地观察了最大阻滞平面并计算出阻滞每对背神经所用局麻药液的容量（节段剂量）。最大平面出现时间和以注药点为起始点向头和尾端双向扩散的节段差。结果显示,T9-10组（66例）和L2-3组（52例）的节段剂量均与年龄呈线性（直线）负相关。T9-10组节段剂量（ml/节）=2.0388-O.0206×年龄（岁）;L2-3组的节段剂量=2.1006-0.0190×年龄。T9-10组中41例的节段剂量与身高呈线性（直线）正相关。T9-10组最大平面出现时间为18.30±4.30min;L2-3组23.71±7.31min。T9-10椎间隙穿刺注药后,药液向头端扩散比尾端多0.83±2.37节段;L2-3组向尾端扩散多0.42±22.51节段。作者体会到,这种局麻配方兼有生效决、透透力强、运动阻滞好和作用时间长的优点。集中推注估计初量易于达到预期的阻滞平面,但有时运动阻滞欠佳,需适当追加。

关键词： epidural analgesia Local anesthetic