분만진통을 위한 아편양제제와 국소마취제의 척수강내 투여와 경막외강 투여의 비교
Comparison of Intrathecal Injection with Epidural Injection of Opioids and Local Anesthetics for Labor Analgesia
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Abstract
Background: Intrathecal sufentanil has been found to provide profound analgesia during labor. The analgesic effect of intrathecal sufentanil, morphine and hyperbaric bupivacaine were compared with that of epidural fentanyl and bupivacaine for labor pain. Methods: Thirty women received either 2 ml of 10μg intrathecal sufentanil with 0.2 mg morphine and 3.5 mg bupivacaine (intrathecal group; n = 15) or 10 ml of 0.125% bupivacaine mixed with fentanyl 5μg/ml (epidural group; n = 15) during active labor. When pain occurred, 50 mg meperidine was injected intravenously in the intrathecal group, or a patient-controlled epidural analgesia (PCEA) pump, using 0.0625% bupivacaine with fentanyl 2μg/ml, was programmed to deliver a 4 ml/h basal infusion and a 4 ml on-demand bolus, with 10-min lockout intervals, was activated in the epidural group. Results: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores did not differ between the two groups. Motor weakness and urinary retention were significantly lower in the intrathecal group (P ＜ 0.05). Conclusions: Intrathecal sufentanil, with morphine and bupivacaine or epidural fentanyl and ropivacaine, provides safe and effective analgesia during labor. However, intrathecal opioids, with low-dose local anesthetics, appear to have lower incidences of motor blockade than epidural local anesthetics, with opioid, in analgesia for labor pains.
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