舒芬太尼复合不同浓度布比卡因用于骨科下肢手术后连续腰麻的临床疗效观察

目的 比较舒芬太尼复合两组浓度布比卡因用于骨科下肢手术后连续腰麻的临床疗效.方法 选取下肢手术后连续腰麻的32例患者为该试验研究对象,采用随机数字表法分为A、B两组,其中A组16例患者接受舒芬太尼(1 mcg · h-1)复合0.125％布比卡因(1 mL·h-1),B组16例患者接受舒芬太尼(1 mcg·h-1)复合0.062 5％布比卡因(2 mL·h-1).基于视觉模拟量表(VAS)评估疼痛强度的镇痛效果.手术后96 h内,记录患者感觉和运动功能,血流动力学和呼吸系统等参数.此外,对关节的活动性进行评估,并记录所发生的任何副作用.结果 25例患者的VAS值≤30 mm.A组和B组各4例和3例患者接受了拯救剂量的布比卡因.A组中位T1h和T4 h VAS值要低于B组,其中T1h(8±11) mmvs (16±11) mm,P＜0.05,T4h (11±8) mmvs (18±1) mm,P＜0.05.所有患者的血流动力学稳定.两组患者术后关节活动度差异无统计学意义.结论 剂量为1.25 mg·h-1布比卡因用于全膝关节和髋关节置换术术后CSA能够提供良好的镇痛效果,而与用药的浓度和溶液总体积无关.

Clinical efficacy of sufentanil plus different concentrations of levobupivacaine through postoperative CSA after major orthopedic surgery GAO Zhenhui,WANG Hongyun (Department of Anesthesia,Central Hospital of Baoji,Baoji,Shaanxi 721000,China) Abstract:Objective

Objective To compare the clinical efficacy of two concentrations of bupivacaine through postoperative CSA after major orthopedic surgery.Methods Thirty-two patients who received continuous spinal anesthesia (CSA) after major orthopedic surgery were chosen and randomly divided into 2 groups.Group A (n =16) received sufentanil (1 mcg · h-1) plus bupivacaine (0.125％-1 mL ·h-1) and Group B (n =16) received sufentanil (1 mcg · h 1) plus bupivacaine (0.0625％-2 mL · h-1).The quality of analgesia was assessed based on pain intensity by Visual Analogic Scale (VAS).Sensory and motor function,hemodynamic,and respiratory parameters were recorded for 96 h after surgery,after which the catheter was removed.In addition,joint mobility was assessed,and any side effects were noted.Results VAS score was ≤30 mm in 25 patients.Three patients in Group A and 4 in Group B received a rescue dose of levobupivacaine.Median VAS in Group A was lower than in Group B on T1 h (8 ± 11) mm vs (16 ± 11) mm,P ＜ 0.05,and on T 4 h (11 ± 8) mm vs (18 ± 1) mm,P ＜ 0.05.All patients remained hemodynamically stable.There were no significant differences between groups for postoperative joints mobility.Conclusions Bupivacaine at a dose of 1.25 mg · h-1 administered by CSA provides good quality analgesia independent of concentration and solution volume in patients undergoing total knee and hip replacement.