Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study

BMC Anesthesiology

Research

Zhenzhen Li¹  Shengyou Wang¹  Haijuan Zhu¹  Yao Lu²  Xiang Ma³  Hao Sun³ 

[1] Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, 230001, Hefei, China;Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 230022, Hefei, China;Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 230022, Hefei, China;Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, 230001, Hefei, China;Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University, 230061, Hefei, China;

关键词: Dexmedetomidine;    Intranasal;    Labor pain;    Onset labor;    Procedural pain;   

DOI  :  10.1186/s12871-023-02146-5

 received in 2023-02-01, accepted in 2023-05-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundEpidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain.MethodsIn this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture.ResultsSeventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8–2.5) vs. 3.5 (3.3–4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups.ConclusionsPretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully.Trial registrationThis trial was prospectively registered at Chictr.org.cn on 29/05/2020 with the registration number ChiCTR2000033356 (http://www.chictr.org.cn/listbycreater.aspx).

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

40517_2023_256_Article_IEq99.gif

40854_2023_494_Article_IEq2.gif

Fig. 1

Fig. 3