So sánh hiệu quả giảm đau trong chuyển dạ của phương pháp gây tê ngoài màng cứng tiêm ngắt quãng theo chương trình bằng ropivacain các thể tích thuốc tê khác nhau kết hợp với fentanyl

Labor is a physiological process, yet it is often accompanied by intense pain, making effective labor analgesia crucial for maternal well-being. Epidural analgesia has long been considered the gold standard, offering selective sensory blockade, high efficacy, and safety for both mother and fetus. The advent of programmed intermittent epidural bolus (PIEB), facilitated by syringe pumps, further refines this technique by improving drug distribution, reducing total anesthetic consumption, and enhancing patient satisfaction compared to continuous epidural infusion. However, most existing research primarily compares PIEB with continuous infusion, with limited studies focusing on the optimal bolus volume within the PIEB regimen itself. This study addresses this gap by evaluating and comparing the analgesic effectiveness of PIEB using Ropivacaine 0.1% combined with Fentanyl at different bolus volumes (6 ml, 8 ml, and 10 ml).

Obstetricians, anesthesiologists, pain management specialists, midwives, and researchers in maternal-fetal medicine and pharmacology.

This study aimed to evaluate and compare the effectiveness of labor analgesia achieved through programmed intermittent epidural bolus (PIEB) using Ropivacaine 0.1% combined with Fentanyl 2 µg/ml at three different bolus volumes: 6 ml, 8 ml, and 10 ml per 60 minutes. Conducted as a randomized controlled clinical trial, the research involved 90 nulliparous women with term pregnancies at the Hanoi Obstetrics and Gynecology Hospital. Participants were randomly assigned to one of three groups, each receiving a specific bolus volume via a Terumo syringe pump. Analgesic effectiveness was primarily assessed using Visual Analog Scale (VAS) scores, the number of rescue doses required, maternal satisfaction, uterine contractions, labor progression, and motor block via the Bromage score, with data analyzed using SPSS 20.0.
The results demonstrated a rapid decrease in VAS scores across all groups, reaching their lowest point within 1 hour and 10 minutes post-anesthesia. Notably, at 1 hour and 40 minutes post-anesthesia, the 10 ml group exhibited superior analgesic efficacy, reflected by the lowest VAS score and the absence of required rescue doses, in contrast to the 6 ml group which had the highest mean number of rescue doses. Maternal satisfaction was significantly higher in the 10 ml group (33.3%) compared to the 8 ml (23.3%) and 6 ml (3.3%) groups. Crucially, motor function was largely preserved (96.7% of women showed Bromage 0), and there were no significant differences in uterine contractions or labor progression among the groups, indicating physiological progression. In conclusion, PIEB with Ropivacaine 0.1% and Fentanyl is a safe and effective method for labor analgesia. The 10 ml bolus volume proved superior in terms of analgesic efficacy, stability, and maternal satisfaction, offering valuable insights for optimizing pain management protocols in obstetrics.