Efficacy and safety of nalbuphine for dural puncture epidural labor analgesia

Abstract

Objective To investigate the efficacy and safety of nalbuphine for dural puncture epidural labor analgesia. Methods A total of 319 primiparous women with a full-term single fetus who received trial of labor were enrolled, and according to the drug used for analgesia, they were divided into sufentanil group (group A with 160 women) and nalbuphine group (group B with 159 women). The women in both groups were given dural puncture epidural labor analgesia, during which 3 mL of 1.5% lidocaine was injected after epidural catheter placement, and then the women in group A were given injection of 0.5 mg/L sufentanil combined with 1 mg/L ropivacaine, while those in group B were given injection of 0.3 g/L nalbuphine combined with 1 mg/L ropi-vacaine, with an initial volume of 6-15 mL. After 30 minutes, an electronic analgesia pump was connected for both groups, and sufentanil and nalbuphine were used for patient-controlled epidural analgesia, respectively. The following indicators were collected and observed: Onset time of analgesia, time of first patient-controlled analgesia (PCA) pressing, number of effective PCA pres-sings, and amount of ropivacaine used; Visual Analogue Scale (VAS) score and Ramsay sedation score before analgesia (T0), at 30 minutes after analgesia (T1), at the time of uterine opening (T2), and during labor (T3); incidence rates of adverse reactions in parturients, including pyrexia, nausea and vomiting, skin pruritus, and postoperative headache; the incidence rate of fetal heart rate deceleration, the proportion of neonates with 1 min Apgar score ≤7 points, umbilical arterial blood gas analysis, and neonatal neurological and adaptive capacity scores. Results Compared with group A, group B had significant reductions in the incidence rates of vomiting and nausea, skin pruritus, fetal heart rate deceleration, and neonatal 1 min Apgar score ≤7 (χ2=4.159-5.628,P<0.05) and significant increases in the number of effective PCA pressings and the amount of ropivacaine used (χ2=8.594,6.363,P<0.05), as well as a significant increase in VAS score of the parturients at T2 and T3 (F=45.314,26.717,P<0.05), while there were no significant differences in the other indicators between the two groups (P>0.05). Conclusion For dural puncture epidural labor analgesia, nalbuphine has a similar analgesic effect to sufentanil in the first stage of labor, with a poorer effect in the second stage of labor, but it can reduce analgesia-related adverse reactions in parturients and has a relatively favorable safety profile in neonates.

Keywords

• nalbuphine|sufentanil|analgesia, obstetrical|analgesia, epidural|spinal puncture|anesthesia, obstetrical|comparative effectiveness research