Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
Objective To explore the effect of epidural analgesia for labor on maternal temperature and the newborns. Methods This randomized trial was performed in West China Second Hospital between December 2015 and July 2016. Fifty puerperants were randomly divided into epidural analgesia (EA) group (natural labor under EA, n=25) or the control group (natural labor using Ramaze breathing method, n=25). Maternal tympanic temperature was recorded once per hour after treating with painless labor or blank control. The serum interleukin-1 beta (IL-1β) and heat shock protein 70 (HSP70) level were measured from the blood of the umbilical cord after the delivery. Apgar scores of the newborns were also recorded. Results There was a significant difference in the temperature between EA and control group one hour after the treatment of painless labor [ (36.9±0.7) and (36.4±0.5)℃]. The level of serum IL-1β and HSP70 were significantly higher in EA group [IL-1β: (0.308±0.036) ng/mL; HSP70: 1.175±0.196] than those in the control group [IL-1β: (0.244±0.031) ng/mL; HSP70: 0.935±0.308] (P<0.05). However, no significant difference was found in the neonatal Apgar score (P>0.05). Conclusions The increase of maternal temperature is greater in the EA labor puerperants compared with that in the controls, which may be related to the increase of IL-1β and HSP70. No adverse effect of labor analgesia on new borns is found
【摘要】目的觀察低濃度羅哌卡因復合舒芬太尼用于分娩鎮痛的效果。方法2007年5月8月按入選標準選擇100例產婦,隨機分成試驗組和對照組,每組50例。試驗組分娩前給予低濃度羅哌卡因加舒芬太尼,對照組不行無痛分娩,通過視覺模擬評分法等指標觀察鎮痛效果。結果試驗組鎮痛后視覺模擬評分較對照組低(Plt;0.05);兩組鎮痛期間血壓、心率差異有統計學意義（Plt;0.05），新生兒Apgar評分比較無統計學意義(Pgt;0.05)。結論聯合應用羅哌卡因和舒芬太尼用于硬膜外分娩鎮痛能取得較好的效果,值得在臨床中推廣應用。
Objective To study the special traits of primiparae’s compliance with labor analgesia, so as to offer individualized analgesia solutions during spontaneous labor. Methods The uniparous primiparae with cephalic presentation between gestational weeks 38 and 40 were divided into two groups based on their educational background (college education or above, and high school education or below), each group with 20 cases. The demographical statistics of the two groups including their State-Trait Anxiety Inventory (STAI) grading, PCA results, and delivery situation were recorded and analyzed. Results Differences in age, height, and weight were not statisticallysignificant (Pgt;0.05); differences in T-AI were not statistically significant (Pgt;0.05); differences in S-AI were statistically significant (Plt;0.05); differences in anxiety and numbers of adding anesthetics were not statistically significant (Pgt;0.05); differences in failure to tolerate labor pains and requiring caesarean section were statistically significant (Plt;0.05). Conclusion Primiparae with higher educational degree tend to have higher S-AI grading and perform poorly in compliance with labor analgesia.
OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.