The Effect Of Intrathecal Butorphanol Combined With Sufentanil In Spinal-epidural Labor Analgesia

Objective The aim of this study was to investigate the effects of the combined spinal-epidural labor analgesia schemes of intrathecal butorphanol combined with sufentanil,followed by continuous epidural infusion of sufentanil combined with low-concentration ropivacaine on opioid-related side effects,analgesic effect,and maternal and infant outcome.MethodsWe selected the pregnant women who requested labor analgesia voluntarily in the delivery room of Longhua Branch of Shenzhen People’s Hospital between July 2020 and October2020.They were divided into 2 groups（be named BS group and S group）by random number table and were enrolled in chronological order.There were 45 cases in each group.The BS group were Intrathecally injected sufentanil 4μg combined with butorphanol15μg added saline to 2ml,and the S group Intrathecally injected sufentanil 4μg added saline to 2ml.Then the two groups were treated with 0.1% Ropivacaine combined with0.3μg/ml Sufentanil infused epidurally continuously.We collected anthropometric data and research indicator data of the research objects.SPSS25.0 statistical software was used for data-analysis.Results1.A total of 90 subjects were included in this study,45 cases in each group.There were not significant differences in age,body mass index（BMI）,ASA grading,gestational age,baseline of uterine dilatation,and basic vital signs between the two groups（P> 0.05）.2.Compared with those before analgesia,the WHO analgesic grade of the two groups was significantly decreased at 30 minutes after analgesia,which was statistically significant（P=0.000<0.01）.And the decrease of the WHO grade between the two groups was similar,which was no obvious Statistical difference（P>0.05）.3.There was no statistical difference in the onset time of analgesia between the two groups（P>0.05）.4.There was a statistical difference in the duration of analgesia between the two groups（P=0.021<0.05）.It was longer in the BS group.5.Compared with the S group,the number of PCA in the BS group was reduced,and the difference was statistically significant（P<0.05）;the total amount of medication used in the BS group was less than that in the S group,but there was no statistical difference between the groups（P>0.05）.6.About the side effects,there was a statistical difference in the incidence of skin itching between the two groups（P=0.001<0.01）.The incidence of nausea and vomiting also had a statistical difference（P=0.035<0.05）.There were no significant differences in the incidence of fever,postpartum urinary retention between the two groups（P>0.05）.There were no side effects such as lower limb motor block,dizziness and shivering in the two groups.7.Compared with the pre-analgesia（t0）,the mean arterial pressure（MAP）and pulse rate（PR）of the two groups show a trend of decreasing at first and then increasing statistically at 30 min after analgesia（t1）,1h after analgesia（t2）,full uterine cervix opening（t3）,and fetal delivery（t4）.Compared with the BS group,MAP in the S group changed more with time,and there was a statistical difference between the two groups（P=0.001<0.01）.The change-amplitude of PR was similar between the two groups with time,there was no statistical difference（P>0.05）.The pulse oxygen saturation（Sp O2）of the two groups was stable and did not change with time（P>0.05）.8.After analgesia,the Ramsay sedation score increased in both groups,but did not more than 3 scores.And the change range of Ramsay score with time was similar between the two groups,which was no statistical difference（P>0.05）.There was no significant difference in the effect of the analgesic regimens on Ramsay sedation score between the BS group and the S group（P>0.05）.9.There were no statistical differences in the way of delivery,the usage of oxytocin,the duration of the second stage of labor,the amount of bleeding during delivery and 24 hours after delivery between the two groups（P>0.05）.10.The hospitalization time in the S group was longer than that in the BS group,and the difference was statistically significant（P=0.006<0.01）.11.There were no significant differences between the two groups in the incidence of abnormal fetal monitoring in 30 min after analgesia,1-minute Apgar score,5-minute Apgar score,umbilical artery blood gas and neonatal transfer rate（P>0.05）.Conclusions1.During spinal-epidural labor analgesia,intrathecal butorphanol combined with sufentanil can significantly reduce μ receptor-related side effects and improve the prognosis of patients,and will not increase side effects such as drowsiness and hemodynamic fluctuations.2.During spinal-epidural labor analgesia,intrathecal proper butorphanol combined with sufentanil can prolong the duration of analgesia,reduce the number of PCA,and ensure the quality of analgesia.3.During spinal-epidural labor analgesia,intrathecal butorphanol combined with sufentanil will not increase the rate of cesarean section or midwifery,the oxytocin use,the second stage of labor,not prolong the second stage of labor,not increase the amount of bleeding during delivery and postpartum,and can shorten the duration of postpartum hospitalization.It does not affect the outcome of pregnant women and newborns.