Objective To investigate the effect of hydromorphone used for epidural labor analgesia on maternal intrapartum fever, analgesic effect and side effects.
Methods A total of 425 singleton pregnancy, cephalic presentation parturients without contraindications for spinal canal anesthesia and requiring epidurallabor analgesia, aged 20-40 years, BMI 20-30 kg/m2, ASA physical status Ⅰ or Ⅱ, in gestational age 37-42 weeks, were randomly divided into three groups: ropivacaine group (group R, n = 145), hydromorphone group (group H, n = 142), and ropivacaine + hydromorphone group (group RH, n = 138). Patient controlled epidural spontaneous analgesia (PCEA) was used to perform delivery analgesia, and the drug concentrations of the analgesic pump in groups R, H, and RH were 0.1% ropivacaine, hydromorphone 40 μg/ml, and 0.1% ropivacaine + hydromorphone 15 μg/ml, respectively. VAS scores before analgesia, 1, 2, 3, 4, and 5 hours after analgesia, immediately after delivery of the fetus, and 1 hour after parturition were recorded. The incidence of intrapartum fever, the number of vaginal examinations, the duration of labor, the time from rupture to fetal delivery, analgesia time, dosage of anesthetic drugs, the effective and total compressions of PCEA, weight of the newborn, and 1 minute and 5 minutes Apgar scores of newborn were recorded. Umbilical artery blood was taken 1 ml for blood gas analysis, pH, BE value, and concentration of Lac were recorded. Adverse reactions such as nausea, vomiting, dizziness, chills, itching, drowsiness, and hypotension were recorded.
Results Compared with group R, VAS scores at 2, 3, 4, and 5 hours after analgesia, and immediately after delivery of the fetus were significantly decreased in groups H and RH (P < 0.05), the incidence of intrapartum fever, pH of umbilical artery blood, the incidence of chills were significantly decreased, the effective and total compressions of PCEA were significantly reduced, and the incidence of nausea, vomiting, itching, and drowsiness were significantly increased in group H (P < 0.05), the time from rupture to fetal delivery and analgesia time were significantly prolonged, pH of umbilical artery blood was significantly decreased, the incidence of nausea and vomiting were significantly increased in group RH (P < 0.05). Compared with group H, the incidence of intrapartum fever and chills were significantly increased, the time from rupture to fetal delivery was significantly prolonged, the dosage of hydromorphone was significantly reduced, the incidence of dizziness and drowsiness were significantly decreased in group RH (P < 0.05).
Conclusion Hydromorphone used for epidural labor analgesia could produce good analgesic effect without causing intrapartum fever. However, it may cause a higher incidence of adverse reactions. |
