Effect of epidural injection with different doses of 1.5% chloroprocaine in relieving breakthrough pain during labor analgesia

doi:10.11958/20230652

Abstract

Abstract:

Objective To investigate the effect of epidural injection of 1.5% chloroprocaine on breakthrough pain during labor analgesia. Methods A total of 128 primiparas with breakthrough pain after epidural labor analgesia were randomly divided into four groups (R, C₁, C₂ and C₃groups). When breakthrough pain occurred, 0.15% ropivacaine 6 mL was injected epidural in the group R, and 1.5% chloroprocaine 6, 8 and 10 mL were injected epidural in the group C₁, the group C₂ and the group C₃, respectively. The visual analogue score (VAS) for pain was assessed every 3 minutes after the administration of local anesthetics. The primary outcome was recorded including the onset time of breakthrough pain after the administration and the success rate of breakthrough pain treatment. Secondary outcome included rescue analgesia rate, maternal satisfaction (5 minutes after administration of breakthrough pain, 24 hours after the delivery), VAS, modified Bromage score, fetal heart rate (FHR) at first breakthrough pain (T₀), 3 min (T₁), 6 min (T₂), 9min (T₃), 12 min (T₄), 15 min (T₅) and 18 min (T₆) after administration, the interval and duration of uterine contraction at the onset time of breakthrough pain, the second, fourth, sixth, eighth, tenth and twelfth contractions after administration, Apgar score in 1 and 5 min and adverse reactions. Results Kaplan-Meier survival analysis showed that the median onset time (95%CI) of breakthrough pain in the group R, the group C₁, the group C₂ and the group C₃ were 14.3 (13.4-15.2) min, 6.6 (5.6-7.6) min, 5.9 (5.0-6.8) min and 4.7 (3.9-5.4) min, respectively. The onset time of administration was significantly faster in the group C₃ than that in the group C₁ and the group C₂ (Log-rank χ² was 9.852 and 5.325, P<0.05). Compared with the group R, the success rate of breakthrough pain treatment and maternal satisfaction (5 minutes after administration, 24 hours after the delivery) were significantly increased in the group C₂ and the group C₃, and remedial analgesia rate was significantly decreased in the group C₃ (P < 0.01). Compared with the group C₁, the success rate of breakthrough pain treatment was increased and the remedial analgesia rate was decreased in the group C₃ Maternal satisfaction (5 minutes after administration, 24 hours after the delivery ) was significantly increased in the group C₂ and the group C₃(P < 0.01). At T₁, the VAS score was significantly lower in the group C₂ and the group C₃ than that in the group R, and which was significantly lower in the group C₃than that in the group C₁ (P < 0.05). At T_2~5, the VAS score was significantly lower in the group C₁, the group C₂ and the group C₃ than that in the group R, and which was significantly lower in the group C₂ and the group C₃ than that in the group C₁ (P < 0.05). At T₆, VAS scores were significantly lower in the group C₂ and the group C₃ than those of the group R and the group C₁ (P<0.05). There were no significant differences in the interval of uterine contractions and duration of uterine contractions between the four groups. Compared with the group R and the group C₁, the probability of lower limb numbness within 30 minutes after administration of breakthrough pain was significantly higher in the group C₃(P<0.05). There were no significant differences in modified Bromage score, FHR at different time points before and after administration, and Apgar score at 1 and 5 min between the four groups. Conclusion The optimal effective dose of epidural injection of 1.5% chloroprocaine for the treatment of breakthrough pain during labor analgesia is 8 mL.

Key words: labor pain, breakthrough pain, analgesia, obstetrical, analgesia, epidural, chloroprocaine, onset time

CLC Number:

R614

Figures/Tables 6

References 24

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组别	n	年龄/岁	BMI/（kg/m²）	孕龄/周	宫颈口直径/cm	ASA分级（Ⅰ/Ⅱ）	基线FHR/（次/min）	基础MAP/mmHg
R组	29	26.5±3.5	26.9±3.6	39.6（38.4，40.5）	2.0（2.0，3.0）	25/4	133.0±6.2	117.8±9.0
C₁组	27	25.7±3.3	26.5±3.3	39.9（38.7，40.6）	2.0（2.0，3.0）	22/5	134.6±5.8	118.5±10.0
C₂组	28	25.9±3.8	26.8±2.8	39.6（38.9，40.6）	2.0（2.0，3.0）	23/5	133.8±8.1	116.7±10.4
C₃组	27	26.6±3.2	27.1±2.8	39.4（38.3，40.4）	2.0（2.0，3.0）	23/4	131.9±6.0	117.4±7.5
F或χ²		0.443	0.152	0.571	0.155	0.957^▲	0.797	0.173

组别	n	年龄/岁	BMI/（kg/m²）	孕龄/周	宫颈口直径/cm	ASA分级（Ⅰ/Ⅱ）	基线FHR/（次/min）	基础MAP/mmHg
R组	29	26.5±3.5	26.9±3.6	39.6（38.4，40.5）	2.0（2.0，3.0）	25/4	133.0±6.2	117.8±9.0
C₁组	27	25.7±3.3	26.5±3.3	39.9（38.7，40.6）	2.0（2.0，3.0）	22/5	134.6±5.8	118.5±10.0
C₂组	28	25.9±3.8	26.8±2.8	39.6（38.9，40.6）	2.0（2.0，3.0）	23/5	133.8±8.1	116.7±10.4
C₃组	27	26.6±3.2	27.1±2.8	39.4（38.3，40.4）	2.0（2.0，3.0）	23/4	131.9±6.0	117.4±7.5
F或χ²		0.443	0.152	0.571	0.155	0.957^▲	0.797	0.173

组别	n	爆发痛治疗成功	补救镇痛	产妇满意度		爆发痛发生次数（1次/2次）	首次爆发痛发生时间/min	首次爆发痛宫口直径/cm
组别	n	爆发痛治疗成功	补救镇痛	爆发痛给药后5 min	胎儿娩出后24 h	爆发痛发生次数（1次/2次）	首次爆发痛发生时间/min	首次爆发痛宫口直径/cm
R组	29	14（48.3）	10（34.5）	8.0（7.0，9.0）	8.0（8.0，9.0）	26/3	130（110，160）	8.0（7.0，9.0）
C₁组	27	18（66.7）	8（29.6）	9.0（8.0，9.0）	9.0（8.0，9.0）	23/4	135（112，163）	8.0（7.0，9.0）
C₂组	28	23（82.1）^a	3（10.7）	9.0（9.0，9.0）^ab	9.0（9.0，10.0）^ab	25/3	130（100，160）	8.0（6.5，9.0）
C₃组	27	26（96.3）^ab	0^ab	9.0（9.0，10.0）^ab	10.0（9.0，10.0）^ab	25/2	140（110，168）	8.0（7.0，9.0）
F或χ²		18.154^＊＊	14.127^＊＊	25.179^＊＊	41.462^＊＊	0.876^▲	0.534	0.118

组别	n	爆发痛治疗成功	补救镇痛	产妇满意度		爆发痛发生次数（1次/2次）	首次爆发痛发生时间/min	首次爆发痛宫口直径/cm
组别	n	爆发痛治疗成功	补救镇痛	爆发痛给药后5 min	胎儿娩出后24 h	爆发痛发生次数（1次/2次）	首次爆发痛发生时间/min	首次爆发痛宫口直径/cm
R组	29	14（48.3）	10（34.5）	8.0（7.0，9.0）	8.0（8.0，9.0）	26/3	130（110，160）	8.0（7.0，9.0）
C₁组	27	18（66.7）	8（29.6）	9.0（8.0，9.0）	9.0（8.0，9.0）	23/4	135（112，163）	8.0（7.0，9.0）
C₂组	28	23（82.1）^a	3（10.7）	9.0（9.0，9.0）^ab	9.0（9.0，10.0）^ab	25/3	130（100，160）	8.0（6.5，9.0）
C₃组	27	26（96.3）^ab	0^ab	9.0（9.0，10.0）^ab	10.0（9.0，10.0）^ab	25/2	140（110，168）	8.0（7.0，9.0）
F或χ²		18.154^＊＊	14.127^＊＊	25.179^＊＊	41.462^＊＊	0.876^▲	0.534	0.118

组别	n			疼痛VAS/分
组别	n			T₀			T₁		T₂		T₃			T₄			T₅		T₆		F
R组	29			8.0±1.3			7.8±1.2		7.3±0.9^A		6.7±1.0^A			5.9±1.0^A			4.9±0.7^A		4.6±0.7^A		39.539^＊＊
C₁组	27			7.9±1.5			7.1±1.5^A		6.4±1.2^Aa		5.5±1.4^Aa			4.5±1.2^Aa			4.3±1.2^Aa		4.3±1.1^A		39.710^＊＊
C₂组	28			8.1±1.4			6.8±1.4^Aa		5.5±1.4^Aab		4.4±1.1^Aab			3.8±0.8^Aab			3.7±0.5^Aab		3.7±0.5^Aab		62.789^＊＊
C₃组	27			7.9±1.4			6.3±1.5^Aab		4.9±1.3^Aab		3.9±1.0^Aab			3.4±0.6^Aab			3.4±0.6^Aab		3.4±0.6^Aab		67.934^＊＊
F				0.145			5.836^＊＊		20.008^＊＊		33.875^＊＊			40.715^＊＊			17.768^＊＊		13.098^＊＊
组别		改良Bromage评分/分
组别		T₀			T₁			T₂				T₃			T₄			T₅		T₆
R组		5.00±0.00			5.00±0.00			5.00±0.03^AB				5.00±0.04^AB			5.00±0.04^AB			4.97±0.04^AB		4.97±0.03^AB
C₁组		5.00±0.00			5.00±0.00			5.00±0.04^AB				4.96±0.04^AB			4.96±0.04^AB			5.00±0.04^AB		5.00±0.04^AB
C₂组		5.00±0.00			5.00±0.00			4.96±0.03^AB				4.93±0.04^AB			4.93±0.04^AB			4.93±0.04^AB		4.96±0.04^AB
C₃组		5.00±0.00			5.00±0.00			4.89±0.04^AB				4.89±0.04^AB			4.93±0.04^AB			4.93±0.04^AB		4.93±0.04^AB
组别			FHR/（次/min）
组别			T₀			T₁				T₂			T₃			T₄		T₅		T₆
R组			134.2±6.5			132.3±5.9				134.9±8.8			133.0±9.0			132.6±8.4		134.3±11.3		135.9±10.9
C₁组			135.7±5.4			134.8±7.0				132.8±8.5			134.3±10.9			130.9±9.6		135.9±9.3		136.4±11.1
C₂组			134.3±8.9			132.6±6.8				133.7±9.2			134.5±7.7			133.1±10.5		133.5±7.7		131.6±7.4
C₃组			136.0±5.5			132.6±5.8				133.8±9.9			130.5±7.3			135.4±8.2		131.8±6.9		135.4±8.5