A Clinical Study For Different Doses Of Fentanyl Plus Ropivacaine With Combined Subarachaoid Epidural Analgesia During Labor

Objective:To assess the effect of analgesia and safety in labor,our present study used different doses of fentanyl plus 3mg ropivacaine for combined subarachaoid-epidural anesthesia during labor.These can provide basis for reasonable administration in labor analgesia.Method:120 parturients were divided into six groups randomly,which fentanyl 2.5ug + ropivacaine 3mg (Group A) fentanyl 5ug+ ropivacaine 3mg (Group B) fentanyl 10mg +ropivacaine 3mg (Group C) . fentanyl 15ug + ropivacaine 3mg (Group D) fentanyl 20ug + ropivacaine 3mg (Group E) fentanyl 25ug + ropivacaine 3mg (Group F)were injected respectively into subarachnoid space . The PC A (patient-controlled analgesia) pump (0.15% ropivacaine +2ug/ml fentanyl )wasapplied to supply analgesia,when uterine contraction pain VAS(visual analog score)≥ 3.The onset and duration of subarachaoid analgesia were observed,VAS were recorded respectively before injection and 5min 10min , 30 min 60min after injection in 10cm cervical dilation at labor and 24h after labor, MBS(modified bromage score) and Ramesay score of parturients, the effect of respiration and circulation by analgesia labor stage and labor type, adverse reactions of parturients, FHR(fetal heart rate) and the Apgar score of neonate were recorded respectively.Results:There was no significant difference in genaral data and obstetric character of six groups. VAS declined gradually after injection compaired with before injection. Compaired with group A group B group C, group D group E group F has significant difference in the onset and duration of subarachaoid analgesia. MBS of most parturients were 0 and no motor block, There were no significant differences of MAP HR, RRn SpO2 at different time in six groups. There were no statistic differences in the first the second and the third stage of labor. The rate of obstetric forceps and the rate of caesarean section of parturients were low and no statistic differences in six grougs. In group A group B and group C, Ramesay scores were low and a few of parturients were worrying at 5min 10min 30min after iniection; in group D group E and group F, Ramesay scores were high and a few of parturients were sleeping at 30min 60min after injection.FHR were shortly bradycardia in group E and group F, respectively 2 cases and 3 cases.Conclusion:Subarachaoid analgesia (fentanyl 15ug + ropivacaine 3mg) and patient control epidural analgesia(0.15% ropivacaine +2ug/ml fentanyl) i.e. CSEA+PCEA can offersafety and efficacy of labor analgesia at present. Fentanyl 15ug is the best dose with subarachaoid analgesia during labor.