Comparison of ropivacaine plus sufentanil and ropivacaine plus dexmedetomidine for labor epidural analgesia

Chen, Gang; Gong, Maolian; Yi, Liu

doi:10.1097/md.0000000000022113

“…It is suggested that the whole-labor MMA regimen has no adverse effects on the newborn and is safe. To analyze the reasons, the drugs ropivacaine and sufentanil used in PCEA in this study hardly pass the placental barrier, have no inhibition on neonatal breathing, and do not affect the uteroplacental blood circulation [ 20 , 21 ]. And when it is combined with auricular acupoint pressing, TENS, and acupoint injection during the incubation period, it not only gives full play to the sedative and analgesic effects of multiple-acupoint stimulation to ensure full analgesia during labor but also fully ensures the safety of the newborn.…”

Section: Discussionmentioning

confidence: 99%

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara

Liu

¹

,

Men

²

,

Song

³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Purpose. To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara. Methods. 300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T0), at full opening of the uterus (T1), at the end of the second stage of labor (T2), and at the end of the third stage of labor (T3); stress response indicators at T0 and T1: epinephrine (E), norepinephrine (NE), glucose (Glu), and β-endorphin (β-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2); incidence of postpartum depression (PPD) at 6 weeks after delivery. Results. At T1, T2, and T3, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W ( P < 0.05 ). At T0, there was no significant difference in the comparison of E, NE, Glu, and β-EP levels among the three groups ( P > 0.05 ). At T1, the levels of E, NE, Glu, and β-EP were higher in the three groups than in the same group at T0, the levels of E, NE, and Glu were lower, the levels of β-EP were higher in groups W and WM than in group A, and the levels of β-EP were higher in group WM than in group W ( P < 0.05 ). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W ( P < 0.05 ). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference ( P > 0.05 ). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference ( P > 0.05 ). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference ( P > 0.05 ). Comparing the PH, BE, PaO2, and PaCO2 of three groups of newborns after delivery, there were no significant differences ( P > 0.05 ). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) ( P < 0.05 ). Conclusion. The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.

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“…Dexmedetomidine (Dex) is a highly selective α 2-adrenergic receptor agonist, which can act directly on peripheral α 2 receptors, reduce the release of norepinephrine, and further show sedative and analgesic effects [ 16 ]. Chen et al [ 17 ] applied Dex combined with ropivacaine in parturition analgesia successfully with excellent application effects.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effects of Dexmedetomidine Combined with Spinal and Epidural Anesthesia Nursing on Prostate Hyperplasia Patients after Transurethral Resection of Prostate by Intelligent Algorithm-Based Magnetic Resonance Imaging

Zhang

¹

,

Bo

²

,

Zeng

³

et al. 2022

Computational and Mathematical Methods in Medicine

1

0

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To analyze the investigation of the application effects of different doses of dexmedetomidine (Dex) with combined spinal and epidural anesthesia nursing on analgesia after transurethral resection of prostate (TURP) by intelligent algorithm-based magnetic resonance imaging (MRI), MRI imaging segmentation model of mask regions with convolutional neural network (Mask R-CNN) features was proposed in the research. Besides, the segmentation effects of Mask R-CNN, U-net, and V-net algorithms were compared and analyzed. Meanwhile, a total of 184 patients receiving TURP were selected as the research objects, and they were divided into A, B, C, and D groups based on random number table method, each group including 46 cases. Patients in each group were offered different doses of Dex, and visual analogue scale (VAS) and Ramsay scores of different follow-up visit time, use of other analgesics, the incidence of postoperative cystospasm, and nursing satisfaction of patients in four groups were compared. The results demonstrated that Dice similarity coefficient (DSC) value, specificity, and positive predictive value of Mask R-CNN algorithm were 0.623 ± 0.084 , 98.61%, and 69.57%, respectively, all of which were higher than those of U-net and V-net algorithms. Pain VAS scores and the incidence of cystospasm at different time periods of groups B and C were both significantly lower than those of group D ( P < 0.05 ). Ramsay scores of groups B and C at 8 hours, 12 hours, 24 hours, and 48 hours after the operation were all remarkably higher than those in group D ( P < 0.05 ). Besides, nursing satisfaction of groups B and C was obviously superior to that in group D, and the difference demonstrated statistical meaning ( P < 0.05 ). The differences revealed that Dex showed excellent analgesic and sedative effects and could effectively reduce the incidence of complications after TURP, including cystospasm and nausea. In addition, it helped improve nursing satisfaction and patient prognosis.

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“…7 A prior study found that epidural administration of 0.08% ropivacaine + 0.5 μg/mL DEX had the optimal effect, with high maternal satisfaction. 8 Similarly, another study also reported that when DEX was combined with 0.1% ropivacaine, 0.5 μg/mL was the appropriate concentration of DEX for epidural labor analgesia. 9 In the present study, we observed more parturients with Bromage scores of ≥2 in the S0.3 group than in the remaining 3 groups when the VAS score was maintained between 0 and 3 throughout labor (P < .05).…”

Section: Discussionmentioning

confidence: 94%

The Influence of Dexmedetomidine as an Adjuvant in Intrathecal Labor Analgesia: A Multicenter Study on Efficacy and Maternal Satisfaction

Lao,

Zhu,

Yang

et al. 2023

The Journal of Clinical Pharma

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In this study, we examined the impact of dexmedetomidine (DEX) on the effectiveness of epidural analgesia and labor outcomes. We administered different doses of DEX combined with 0.1% ropivacaine for epidural analgesia to evaluate their clinical effects and safety. To assess the effects of different concentrations of DEX in parturient women receiving epidural analgesia, we conducted a randomized double‐blind trial. We selected 400 parturient women and randomly assigned them to four groups, with 100 parturient women in each group: S0.1 (0.1μg/ml DEX), S0.2 (0.2μg/ml DEX), S0.3 (0.3μg/ml DEX), and a control group (0.3μg/ml sufentanil). Post‐analgesia, we recorded the bromage scores, labor duration, method of delivery, bleeding, neonatal Apgar scores, adverse reactions, and maternal satisfaction. The number of patients with Bromage score ≥ 2 and the incidence of bradycardia were higher in the S0.3 group compared to the other three groups (P < 0.05), while the high satisfaction rate was lower in the S0.3 group (P < 0.05). Moreover, we found that the number of times additional patient‐controlled analgesia was administered was higher in the S0.1 group compared to the remaining three groups (P < 0.05). The control group exhibited a higher incidence of pruritus than the other three groups (P < 0.05). In conclusion, for labor pain relief during spinal anesthesia, epidural analgesia with 0.1% ropivacaine combined with 0.2 μg/ml DEX provides relatively ideal analgesic effects, higher maternal satisfaction, and reduces the incidence of pruritus compared to the combination of 0.1% ropivacaine and 0.3 μg/mL sufentanil.This article is protected by copyright. All rights reserved

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Comparison of ropivacaine plus sufentanil and ropivacaine plus dexmedetomidine for labor epidural analgesia

Cited by 12 publications

References 15 publications

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara

Analgesic Effects of Dexmedetomidine Combined with Spinal and Epidural Anesthesia Nursing on Prostate Hyperplasia Patients after Transurethral Resection of Prostate by Intelligent Algorithm-Based Magnetic Resonance Imaging

The Influence of Dexmedetomidine as an Adjuvant in Intrathecal Labor Analgesia: A Multicenter Study on Efficacy and Maternal Satisfaction

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