神经刺激器引导用于臂丛神经阻滞及术后镇痛研究

目的 观察神经刺激器定位下经斜角肌间沟留置导管用于持续臂丛神经阻滞及术后镇痛的临床效果和可行性。方法 ASAⅠ～Ⅱ级上肢手术患者60例。随机分为套管针组（A组）和留置导管组（B组），每组30例。A组患者用20G静脉穿刺套管针行常规方法臂丛神经阻滞留置，B组患者在周围神经刺激器引导下穿刺置入专用的柔软导管，手术结束后两组患者均连接一电子镇痛泵行持续术后臂丛神经阻滞镇痛。结果 术中需辅助用药患者两组无统计学差异（P〉0．05）。A组患者术后镇痛失败率达23．3％，B组无镇痛失败患者，两组比较差异有显著性（P〈0．05）。剔除A组镇痛失败患者后，两组患者术后48h内的VAS评分、Ramsay评分和PCA按压次数无统计学差异（P〉0．05）。结论 周围神经刺激器精确引导下经斜角肌间沟留置导管行臂丛神经阻滞和持续术后镇痛是一种可行性好、镇痛效果确切、不良反应少的方法。     

超声引导腹横肌平面阻滞用于剖宫产术术后镇痛的效果研究

目的：观察超声引导下腹横肌平面（TAP）阻滞用于剖宫产术患者术后镇痛的效果。方法择期腰硬联合麻醉下行剖宫产术患者60例,ASA分级Ⅰ级或Ⅱ级,分为罗哌卡因组（Ⅰ组）和等量0.9%氯化钠溶液组（Ⅱ组）。手术完成后在超声引导下行双侧TAP阻滞,Ⅰ组每侧注射0.375%罗哌卡因20ml,Ⅱ组每侧注射等容量0.9%氯化钠溶液。术毕所有患者均行经静脉患者自控镇痛（PCIA）。比较两组术后2 h、6 h、12 h、24 h、48 h静态和动态视觉模拟疼痛（VAS）评分,记录两组术后镇痛泵第一次按压时间、24 h镇痛泵按压次数、镇痛满意度、PCIA的用量以及不良反应的发生情况。结果两组术后2 h、6 h、12 h、24 h、48 h的静态VAS评分比较,差异无统计学意义（t分别=1.85、1.96、1.99、1.96、1.63,P均＞0.05）。Ⅰ组术后2 h、6 h、12 h和24 h时点的动态VAS评分明显低于Ⅱ组,差异有统计学意义（t分别=4.46、4.95、5.13、3.08,P均＜0.05）。Ⅰ组术后镇痛泵第一次按压时间比Ⅱ组延迟（t=6.82,P＜0.05）,24 h镇痛泵按压次数比Ⅱ组少（t=6.17,P＜0.05）,镇痛满意度比Ⅱ组高（χ2=4.32,P＜0.05）,术后24 h内PCIA使用量比Ⅱ组更少（t=7.32,P＜0.05）。两组均未见与TAP穿刺相关的并发症,两组术后恶心、呕吐等不良反应发生率的比较,差异无统计学意义（χ2分别=0.23、0.10,P均＞0.05）。结论超声引导下TAP阻滞用于剖宫产术患者的术后镇痛效果好,减少了PCIA的需要量。     

超声引导下外侧入路腰方肌阻滞对剖宫产产后镇痛效果和泌乳的影响

目的 探讨超声引导下外侧入路腰方肌阻滞对剖宫产产后镇痛效果和泌乳的影响.方法 选取剖宫产孕妇120例,随机分为观察组和对照组,观察组术后给予超声引导外侧入路腰方肌阻滞+静脉自控镇痛;对照组术后仅行静脉自控镇痛.观察两组术后6 h、12 h、24 h和48 h静息、运动视觉模拟评分法(VAS)评分和Ramsay镇静评分,...     

超声引导下臂丛神经阻滞术后留置导管对肘关节骨折患者术后镇痛及功能锻炼的影响

目的 探讨超声引导下臂丛神经阻滞术后留置导管对肘关节骨折患者术后镇痛及功能锻炼的影响.方法 将60例行臂丛神经阻滞术后的肘关节骨折患者随机分为对照组与研究组,各30例.对照组术后留置导管采用外周神经刺激器引导,研究组采用超声引导.比较两组的临床效果.结果 研究组的置管次数、手术时间、药液渗漏发生率、辅助镇痛率、罗哌卡因...     

A prospective randomized pilot comparison of intranasal fentanyl and intramuscular morphine for analgesia in children presenting to the emergency department with clinical fractures

Abstract Objective: To evaluate the tolerability and efficacy of intranasal fentanyl analgesia for children. Methods: A prospective, open-label, two-arm pilot study was conducted. Children, aged 3 to 10 years, with clinical limb fractures were randomized to receive 1 μg/kg intranasal fentanyl via nasal spray or 0.2 mg/kg intramuscular morphine. Tolerance to administration, pain scores, rescue analgesia, adverse events and physiological data were recorded at intervals over 30 min. Results: Forty-seven children were recruited to the study. Tolerance to administration was better for intranasal fentanyl compared with intramuscular morphine (median scores 1 vs 2; P < 0.001). Pain scores over the trial period were similar in both groups. One child receiving intranasal fentanyl required rescue analgesia. No significant adverse effects were noted. Conclusions: Intranasal fentanyl provides effective paediatric analgesia comparable to intramuscular morphine and is better tolerated. A larger study is needed to determine dose range and confirm safety.     

超声引导竖脊肌平面阻滞对胸腔镜肺叶切除患者术后镇痛和细胞免疫功能的影响

目的观察超声引导下竖脊肌平面(ESP)阻滞对胸腔镜下肺叶切除患者术后镇痛和细胞免疫功能的影响。方法选择择期胸腔镜下肺叶切除术患者90例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级。随机分为单纯静脉全麻组(C组)、椎旁神经阻滞+静脉全麻组(P组)和ESP阻滞+静脉全麻组(E组)。E组和P组分别在全麻诱导前行超声引导下ESP阻滞和椎旁神经阻滞,20 min后测定阻滞范围和效果,术毕3组均采用静脉自控镇痛(PCIA)。记录入手术室(T_0)、麻醉诱导前(T_1)、切皮即刻(T_2)和术毕(T_3)3组患者平均动脉压(MAP)和心率(HR);记录术后2 h (T_4)、8 h (T_5)、12 h (T_6)、24 h (T_7)和48 h (T_8)静态数字疼痛评分[NRS(R)]和动态NRS评分[NRS(M)];并于T_0、T_3、T_7和T_8抽取静脉血5 mL,检测血液自然杀伤(NK)细胞数目和Th1/Th2比值;记录术后镇痛泵按压次数、药物输注总量、曲马多给药次数和术后不良反应发生情况。结果与T_0比较,P组患者在T_1时点MAP降低、HR增快(P 0.05),C组患者T_2和T_3时点MAP增高、HR增快(P 0.05);P组和E组患者T_2和T_3时点MAP低于C组、HR慢于C组(P 0.05);C组和E组患者T_1时点MAP高于P组、HR慢于P组(P 0.05);P组和E组患者术后T_4～T_6时点的NRS(R)低于C组(P 0.05),E组患者术后T_7时点NRS (R)低于C组(P 0.05);P组和E组患者术后T_4～T_6时点的NRS (M)低于C组(P 0.05);P组和E组各时点NRS比较,差异无统计学意义(P 0.05)。各组患者在T_3、T_7和T_8时点NK细胞数目、Th1/Th2比值均较T_0降低,E组和P组在T_3、T_7和T_8时点NK细胞数目、Th1/Th2比值高于C组(P 0.05),E组和P组比较,差异无统计学意义(P 0.05);E组和P组术中瑞芬太尼用量、镇痛泵按压次数、药物输注总量和曲马多给药次数均明显少于C组(P 0.05),E组与P组比较,差异无统计学意义。P组术后低血压发生率高于C组和E组(P 0.05)、C组术后恶心呕吐发生率高于P组和E组(P 0.05)。结论超声引导下ESP阻滞,对胸腔镜下肺叶切除患者术后疼痛和免疫功能的影响与椎旁神经阻滞相当,但对患者循环影响更小。     

超声引导下腰方肌后阻滞和连续硬膜外镇痛对剖宫产术后镇痛效果的比较

目的 比较腰方肌阻滞(QLB)和连续硬膜外镇痛在剖宫产术后的镇痛效果。方法 前瞻性选取2019年4~10月首都医科大学附属北京友谊医院收治的行剖宫产的产妇60例,采用随机数字表法将其分为三组:腰方肌阻滞组(QLB组)、连续硬膜外镇痛组(PECA组)和腰方肌阻滞+连续硬膜外镇痛组(QLB+PCEA组),每组各20例。于剖宫产术后,给予PCEA组和QLB+PCEA组产妇连接硬膜外镇痛泵,镇痛泵配方为150 mg罗哌卡因、50μg舒芬太尼用生理盐水配至250 ml。给予QLB组和QLB+PCEA组产妇行超声引导下双侧腰方肌阻滞,采用腰方肌后阻滞,给予0.375%的罗哌卡因两侧各25 ml。记录以下指标:①三组产妇术后6 h、12 h、24 h、48 h产妇的静态疼痛VAS评分;②PCEA组和PCEA+QLB组产妇术后24 h、48 h内镇痛泵的按压次数和舒芬太尼用量;③PCEA组和QLB组产妇在镇痛期间不良反应发生情况。结果 QLB组和PCEA组产妇术后6 h、12 h、24 h、48 h静息时疼痛评分比较,差异均无统计学意义(P> 0. 05)。PCEA+QLB组产妇的术后6 h静态疼痛VAS评分(1. 75±0. 50分)、以及12 h静态疼痛VAS评分(1. 00±0. 0分)分别较PCEA组产妇术后6 h(3. 19±1. 11分)和12 h(2. 31±0. 79分)更低,差异具有统计学意义(P <0. 05);24 h、48 h的静息疼痛评分无显著差异;但24 h、48 h内的镇痛泵按压次数明显减少,PCEA组24 h(9. 79±8. 41次)、48 h(11. 68±9. 63次),PCEA+QLB组24 h(3. 11±2. 22次)、48 h(5. 96±4. 57次),差异均具有统计学意义(P <0. 05)。PCEA+QLB组产妇较PCEA组产妇,24 h内使用的舒芬太尼量差异无统计学意义(P> 0. 05);但48 h内使用的舒芬太尼量减少,PCEA组(46. 13±2. 42μg),PCEA+QLB组(9. 71±1. 48μg),差异具有统计学意义(P=0. 039)。QLB组产妇麻醉不良反应发生率为0,PCEA组为20. 0%,显著高于QLB组,差异具有统计学意义(P=0. 035)。结论与连续硬膜外镇痛相比,超声引导下腰方肌后阻滞用于剖宫产术后镇痛,可减少围手术期舒芬太尼用量和麻醉不良反应的发生。     

超声引导连续锁骨下臂丛阻滞术后镇痛效果及对炎性反应的影响

目的比较超声引导下喙突旁入路连续锁骨下臂丛阻滞与舒芬太尼静脉镇痛对上肢多发骨折患者术后镇痛的效果及对炎性因子表达的影响。方法选择ASAⅠ分级上肢多发骨折患者80例,随机分为2组,治疗组(n=40)采用超声引导下喙突旁入路连续锁骨下臂丛阻滞作术后镇痛,对照组(n=40)采用舒芬太尼自控静脉镇痛。记录麻醉前(T1)、术后6h(T2)、术后12h(T3)、术后24h(T4)、术后48h(T5)心率(HR)和平均动脉压(MAP);于T1~T5采集外周静脉血测定血浆白细胞介素-6(IL-6)及白细胞介素-10(IL-10)的浓度;记录T2~T5的静息和主动运动视频模拟评分(VAS);记录术后发生恶心、呕吐的病例数。结果两组HR和MAP比较,在T3和T4时间点,对照组较治疗组升高(P0.05);治疗组T3、T4静息VAS评分和T3、T4、T5主动运动VAS评分均较对照组降低(均P0.05)。IL-6和IL-10组内比较,T2~T5时间点较T1均有不同程度升高(P0.05);两组IL-6比较,在T3、T4时间点治疗组较对照组低(P0.05);两组IL-10比较,在T3、T4时间点治疗组较对照组高(P0.05)。治疗组发生恶心、呕吐率较对照组低(P0.05)。结论超声引导连续锁骨下臂丛神经阻滞术后镇痛安全、可靠、简便,有利于术后细胞因子平衡和减少并发症。     

膝关节镜术后关节腔内注射芬太尼和口服美洛昔康的镇痛效果比较

目的：研究膝关节镜术后关节腔内注射芬太尼和口服非甾体类药物（NSAIDs）美洛昔康的镇痛效果。方法：选取择期行膝关节镜手术患者180例,随机分为3组,每组60例,A组术后关节腔内注入芬太尼,并在术后给予美洛昔康口服;B组术后关节腔内注入芬太尼;C组术后给予美洛昔康口服。分别在术后2、8、24、48、72h,以VAS评估患者术后的疼痛水平。结果：2hA组较B组的评分差异无显著性意义。2h后A组评分较B组更低（P〈0.05）,A组和B组较C组的评分明显降低（P〈0.05）。结论：芬太尼与美洛昔康联合使用可以有效缓解膝关节镜术后疼痛,镇痛效果优于单独使用;芬太尼较美洛昔康效果更佳。     

芬太尼与利多卡因宫旁阻滞麻醉用于人工流产的疗效比较

目的：比较芬太尼与利多卡因宫旁阻滞麻醉在人工流产术中的疗效。方法：选择我院2009年3月～2009年5月门诊终止妊娠早孕妇女100例,分为两组。芬太尼组50例,利多卡因组50例。比较两组宫旁阻滞麻醉镇痛效果及人流综合征发生率。结果：芬太尼组的镇痛效果明显优于利多卡因组,人流综合征的发生率明显低于利多卡因组。结论：芬太尼宫旁阻滞麻醉具有镇痛效果明显,人流综合征发生率低等优点,优于利多卡因麻醉效果。     

Pharmacokinetic Profile and Efficacy of a Fentanyl Transdermal Delivery System for Acute Postoperative Pain after Intra-abdominal Gynecologic Surgery for Cancer

Purpose: This prospective, randomized, single‐blind study evaluated the efficacy and pharmacokinetic profile of a transdermal delivery system for fentanyl to provide relief of acute postoperative pain in patients undergoing intra‐abdominal gynecologic surgery for cancer. Methods: Forty female patients were randomized to either transdermal fentanyl 50 µg/hour (n = 20) or transdermal placebo (n = 20). Transdermal systems were placed 1 hour preoperatively and removed 25 hours later. Pain control was supplemented with a nonopioid drug, bupivacaine 0.125–0.25%, administered through an epidural catheter via patient‐controlled epidural analgesia. Serum fentanyl concentrations, bupivacaine consumption, pain scores [visual analog scale (VAS)], sedation rating score, adverse events, and physiological parameters were recorded for 48 hours postoperatively. Results: The minimum effective concentration of fentanyl in serum (0.63 ng/mL) was achieved at 11.3 ± 4.9 hours after application, and serum concentrations remained above this level until 13 hours after removal. The TTS‐F group had lower VAS pain scores and a significant 66% reduction in utilization of bupivacaine compared with placebo. Pain scores were significantly correlated with serum fentanyl concentration (P = 0.025). All physiological parameters fluctuated within normal range and no differences were observed between treatments. Adverse events were similar between the groups with only the incidence of local erythema significantly higher in the TTS‐F group (30% vs. 5%, P < 0.05), and sedation scores were significantly higher in the TTS‐F group during the immediate postoperative period. Conclusion: The transdermal therapeutic system for administration of fentanyl, combined with epidural administration of a nonopioid analgesic such as bupivacaine is effective in controlling postoperative pain after gynecologic surgery. Additionally, the safety/tolerability of this regimen was similar to placebo plus bupivacaine.     

丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛对乳腺癌术后疼痛的影响

目的：探讨丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛对乳腺癌术后疼痛的影响。方法采用随机综合平衡序贯法将该院于2013年1月至2015年11月收治的69例拟行外科手术的乳腺癌患者分为观察组（34例）和对照组（35例）。对照组给予单纯舒芬太尼术后静脉镇痛,观察组给予丙帕他莫超前镇痛＋舒芬太尼术后静脉镇痛。对比两组术后1h、4h、8h、12h和24 h疼痛程度和认知功能,并观察不良反应。结果术后1 h两组VAS和MMES评分差异均无统计学意义（P＞0．05）,术后4 h、8 h、12 h和24 h观察组VAS和MMES评分均较对照组显著降低（P＜0．05）,且术后4 h、8 h和12 h均较术后1 h显著升高（P＜0．05）,术后24 h均较术后1 h显著降低（P＜0．05）,术后24h均较术后4 h、8 h和12 h显著降低（P＜0．05）;观察组镇痛泵按压次数明显少于对照组,差异有统计学意义（ P＜0．05）;观察组总不良反应发生率为5．88％,较对照组的25．71％显著降低（ P＜0．05）。结论采用丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛可以显著减轻乳腺癌患者术后疼痛程度,还可改善认知功能,且不良反应少,安全可靠,成效显著。     

超声引导臂丛神经穿刺置管在断指再植术后镇痛中的应用

目的探讨超声引导臂丛神经穿刺置管在断指再植术后镇痛的指导价值。方法80例急诊拟行一指或两指断指再植手术的患者（男58例,女22例）,年龄17～67岁,ASAI～III级,无颈部外伤及臂丛神经损伤,按术后镇痛方式随机分为连续臂丛神经阻滞（PCBA组）和静脉镇痛组（PCIA组）。采用视觉模糊评分（VAS）对两组患者术后24h和48h的镇静、镇痛程度进行评价,并记录出现恶心、呕吐、膈神经阻滞等并发症的例数。结果所有患者均能舒适地接受超声引导臂丛神经穿刺过程,术中麻醉效果确切。PCBA组超声引导臂丛穿刺置管过程顺利,全部成功。PCBA组与PCIA组比较,VAS评分和镇静程度差异有显著统计学意义（P〈0．叭）,PCIA组的血管痉挛及恶心、呕吐发生率高于PCBA组。结论应用超声引导臂丛神经穿刺置管具有神经定位准确,成功率高;且PCBA组更好地改善了再植指的血运供应,提高了再植指的成活率,避免了加用阿片类药物引起的恶心、呕吐等并发症,增加了患者的舒适度。     

Continuous intrathecal fentanyl infusion for postoperative analgesia

Following inadvertent dural puncture during epidural catheter placement, a 20 gauge polyethylene catheter was placed in the intrathecal space, and continuous spinal anesthesia with hyperbaric bupivacaine was administered intraoperatively to supplement general anesthesia. Following surgery, a continuous intrathecal fentanyl infusion (0.2 mcg/kg/hr) was administered to provide postoperative analgesia. The child was awake and comfortable throughout this time and required no supplemental analgesic agents. Although epidural catheters are still our preferred method of analgesia, intrathecal fentanyl infusion is one alternative when inadvertent dural puncture occurs.     

Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective

Title. Comparison of postoperative pain management using two patient‐controlled analgesia methods: nursing perspective. Aim. To compare the effect of fentanyl iontophoretic transdermal system and morphine intravenous patient‐controlled analgesia on the time‐efficiency and convenience of postoperative patient care. Background. Intravenous patient‐controlled analgesia with morphine is effectively used to manage postoperative pain; however, it takes time to set up and administer. Methods. Nurses evaluated patient‐care tasks with fentanyl iontophoretic transdermal system and/or morphine intravenous patient‐controlled analgesia in two phase IIIb studies (n = 1305) using a nurse ease‐of‐care questionnaire. A responder for time‐efficiency and convenience responded with one of the top three positive choices on all items; for satisfaction, a responder chose one of the top two positive choices on both items. Data were collected between March 2004 and April 2005. Findings. In both studies, greater proportions of nurses were responders for fentanyl iontophoretic transdermal system than for morphine intravenous patient‐controlled analgesia, respectively, for time‐efficiency [total hip replacement surgery, 80·9% (250/309) vs. 57·7% (172/298), P < 0·001; abdominal/pelvic surgery, 84·8% (162/191) vs. 57·7% (113/196), P < 0·001], convenience [total hip replacement surgery, 85·5% (271/317) vs. 64·1% (191/298), P < 0·001; abdominal/pelvic surgery, 89·2% (166/186) vs. 62·8% (123/196), P < 0·001], and satisfaction [total hip replacement surgery, 66·6% (247/371) vs. 33·3% (108/324), P < 0·001; abdominal/pelvic surgery, 67·4% (155/230) vs. 38·2% (84/220), P < 0·001]. Higher proportions of nurses favoured fentanyl iontophoretic transdermal system than morphine intravenous patient‐controlled analgesia in both studies (P < 0·001). Conclusion. The fentanyl iontophoretic transdermal system appears to be simpler, easier to use, and more satisfactory for nurses than morphine intravenous patient‐controlled analgesia.     

Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

Objectives: Comparison of intranasal fentanyl (INF) and parenteral morphine in children in an ED. Primary objective was to compare time to analgesia from presentation, with secondary objectives to assess patient profiles, specifics of opiate analgesics used plus rate of i.v. access for analgesia alone. Setting: Tertiary paediatric ED. Methods: Retrospective review of case notes identified through controlled drug register. Patients who received INF and/or parenteral morphine between 1 January and 31 March 2005 (before introduction of fentanyl) and in corresponding months in 2006 and 2007 were included. Results: A total of 617 patients were included. Geometric mean time to analgesia was statistically different for INF versus morphine in 2006 (31.2 min, SD 2.6 vs 55.6 min, SD 2.4) and in 2007 (23.7 min, SD 2.8 vs 53.1 min, SD 3.1) (both P < 0.000). Mean initial dose of INF in 2007 was 1.46 µg/kg (SD 0.11) compared with 1.32 µg/kg (SD 0.36) in 2006 [Correction made 22 May 2009 after publication: all 17 instances of fentanyl dosing and concentrations have been corrected from milligrams (mg) to micrograms (µg)]. Mean total dose in 2007 was 2.14 µg/kg (SD 0.93), increased from 1.60 µg/kg (SD 0.56) in 2006. INF was used most commonly for fractures and morphine for abdominal pain. The i.v. access for opiate analgesia decreased from 161/161 (100%) in 2005 to 99/237 (41.8%) in 2007. Conclusion: Use of INF in our paediatric ED setting was associated with a significantly reduced time to analgesia for patients requiring immediate analgesia compared with parenteral morphine. Since the introduction of an INF protocol to our department in mid‐2005, INF use has increased, with a corresponding decrease in the use of morphine and a reduction in i.v. access for analgesia.     

连续臂丛神经阻滞镇痛对断指再植术后缺血再灌注损伤影响的研究

目的研究连续臂丛神经阻滞镇痛对断指再植术后缺血再灌注损伤的影响,并探讨其发生的可能机制。方法将60例急诊行断指再植术患者随机分为术后自控性臂丛神经阻滞镇痛组(CA组)和对照组(NA组),每组30例。观察两组再植指术后血管痉挛、血管栓塞和指体坏死发生例数并计算再植指成活率,记录两组术前(T0)、术后3h(T1)、术后24h(T2)、术后48h(T3)时患侧肘静脉血丙二醛(MDA)和超氧化物歧化酶(SOD)浓度。结果断指再植术后成活率CA组高于NA组,差异有统计学意义(χ2=1.66,P<0.05);血管痉挛、血管栓塞和指体坏死发生例数CA组均低于NA组,差异有统计学意义(χ2分别=3.60、1.67、1.66,P均<0.05)。两组不同时间点间MDA、SOD比较,差异均有统计学意义(F分别=29.43、59.82、15.51、27.53,P均<0.05)。与T0点比较,两组在T1、T2、T3时间点MDA均增高,SOD均降低,差异均有统计学意义(t分别=15.24、13.02、13.48、8.68、14.87、24.42;23.60、17.22、14.63、7.83、12.70、17.71,P均<0.05)。在T1、T2、T3时间点,CA组MDA均低于NA组,SOD均高于NA组,差异均有统计学意义(t分别=2.51、2.26、2.24;2.82、3.04、2.77,P均<0.05)。结论患者自控性连续臂丛神经阻滞镇痛对缺血再灌注的再植指具有保护作用,提高了断指再植的成功率。     

Low dose fentanyl improves continuous bupivacaine epidural analgesia following orthopaedic, urological or general surgery

This retrospective study assessed the clinical efficacy of the addition of low concentrations of fentanyl to bupivacaine 0.125% when infused epidurally for postoperative analgesia. Three patient groups received bupivacaine 0.125% alone (n=70), bupivacaine 0.125% with 1 μg/ml fentanyl (n=100), and bupivacaine 0.125% with 2 μg/ml fentanyl (n=70). The percentage of patients with adequate analgesia (pain score ≤3) was higher in both fentanyl groups compared to the plain bupivacaine group on each of the three study days (p<0.05). Those receiving plain bupivacaine had a greater incidence of patchy or unilateral blocks compared to both fentanyl groups (p<0.05). The higher dose of fentanyl was associated with a greatly increased length of stable analgesia (p<0.01). Patient satisfaction scores were highest in the 2 μg/ml fentanyl group and lowest in the plain bupivacaine group, with significant differences between all groups (p<0.01). The incidence of nausea was significantly greater in the plain bupivacaine group compared to both fentanyl groups (p<0.001); other side effects were similar between the groups. We conclude that the addition of fentanyl 1–2 μg/ml to bupivacaine 0.125% for continuous epidural infusion significantly improved all indicators of analgesic quality, without an attendant increase in side effects in a routine clinical setting and is therefore to be recommended.     

罗哌卡因和布比卡因分别复合芬太尼应用于术后硬膜外镇痛的比较研究

目的比较罗哌卡因和布比卡因分别复合芬太尼用于术后持续硬膜外镇痛(CEA)的临床效果。方法硬膜外麻醉行下腹部手术、美国麻醉医师学会(American Society of Anesthesiologists，ASA)分级Ⅰ～Ⅱ级的50例患者，随机分为罗哌卡因复合芬太尼(RF、)组和布比卡因复合芬太尼(BF)组，每组25例。手术结束前5rain硬膜外腔注入负荷剂量，Rt?组为O．2％罗哌卡因 5μg／ml芬太尼5ml，BF组为O．2％布比卡因 5μg／m1芬太尼5ml。术毕，经硬膜外管持续泵入药物2ml／h，RF组为O．2％罗哌卡因 2μg／ml芬太尼，BF组为O．2％布比卡因 2μg／ml芬太尼。记录启用止痛泵后1h、4h、8h、24h、48h的视觉模拟评分法(VAS)评分、改良Bromage分级。结果50例患者启用止痛泵后48h内生命体征平稳。各时段的VAS评分两组间无显著性差异(P＞O，05)；但改良Bromage分级RF组低于BF组(P＜O．05)。结论罗哌卡因和布比卡因分别复合芬太尼用于术后持续硬膜外镇痛均可取得良好的镇痛效果，而罗哌卡因对运动神经的阻滞较轻，效果更理想。