Efficacy of various epidural analgesia regimens after lung surgery

A prospective study included 90 adult patients undergoing thoracic surgery. After placing an epidural catheter at the Th4-Th5 level, all the patients were randomized in 3 groups. Twenty-nine patients received controlled epidural analgesia (PCEA) with fentanyl, 2 microg/ml, in 0.2% bupivacaine solution (Group 1). In other groups, these analgesics were given either as bolus infections (Group 2; n = 30) or as a continuous epidural infusion of fentanyl, 2 microg/ml, in 0.2% bupivacane solution (Group 3; n = 27). Pain scores and the incidence of adverse effects were assessed within the first 24 hours after surgery. The data were compared using the Student's t-test and x2 test with Bonferroni correction; p < 0.017 was regarded as statistically significant. The VAS scores in coating were significantly lower in Group 1 than in Groups 2 and 3. The need for epidural opioids for adequate analgesia within the first 24 hours after surgery was significantly less in Group 1 than in Groups 2 and 3. There were no excessive sedation episodes in all the groups. In Group 2, the incidence of nausea was 20%. These adverse reactions were not found during PCEA and continuous infusion (p < 0.017). Opioid-induced pruritis was mostly (23%) observed in Group 2. Thoracic PCEA with fentanyl-bupivacaine solution provided adequate postoperative analgesia after thoracotomy and reduced the need for opioids. In addition, PCEA reduced the incidence of adverse reactions of opioids.     

Addition of ketamine to propofol–fentanyl anaesthesia can reduce post-operative pain and epidural analgesic consumption in upper abdominal surgery

The aim of this study was to confirm whether intravenous anaesthesia supplemented with the N-methyl- -aspartate (NMDA) antagonist ketamine could reduce post-operative pain after elective open cholecystectomy. Fifty patients were randomised double-blind to one of the following two groups: PF Group received propofol and fentanyl supplemented with saline infusion; PFK Group received propofol and fentanyl supplemented with ketamine (total dose 2 mg/kg). During the first 48 post-operative hours, epidural analgesia was provided for all patients with patient-controlled epidural analgesia (PCEA) using 0.125% bupivacaine and morphine (0.05 mg/ml). Pain assessments at rest and movement, and cumulative PCEA volume consumed, were recorded at 5, 24 and 48 h post-operatively. The visual analogue scale (VAS) scores at rest were significantly less in the PFK Group than in the PF Group at 5, 24 and 48 h (P<0.001, P<0.001 and P=0.02, respectively). The VAS score at movement were also significantly (P<0.001) less throughout this study than in the PF Group. The difference in PCEA analgesic consumption at 0–5 and 5–24 h reached statistical significance (P<0.001 and P=0.008, respectively). Our results show that an intra-operative ketamine dose provides advantages for post-operative analgesia beyond its duration of action after an open cholecystectomy.     

Dexmedetomidine as an adjunct to epidural analgesia after abdominal surgery in elderly intensive care patients: A prospective, double-blind, clinical trial

Background: The ideal postoperative analgesia management of elderly surgical patients in intensive care units (ICUs) is continually being investigated.Objective: The purpose of this study was to assess the effectiveness and tolerability of IV administration of dexmedetomidine as an adjunct to a low-dose epidural bupivacaine infusion for postoperative analgesia after abdominal surgery in elderly patients in the ICU.Methods: ICU patients aged >70 years undergoing abdominal surgery were eligible for the study. A lumbar epidural catheter was inserted at the beginning of the surgery with no medication. On arrival at the ICU, the catheter was loaded with 0.25% bupivacaine 25 mg at the T8 to T10 sensory level, and a continuous infusion of 0.125% bupivacaine was started at 4 to 6 mL/h in combination with patient-controlled epidural analgesia (PCEA) of fentanyl (4 μg/bolus) for pain treatment. Patients in the treatment group received dexmedetomidine as an IV loading dose of 0.6 pg/kg for 30 minutes followed by continuous infusion at 0.2 μg/kg · h^-1. Patients in the control group were not administered dexmedetomidine. The effectiveness of the pain relief was determined using a visual analog scale (VAS) (0 = no pain to 10 = worst pain imaginable) at rest. VAS score, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and arterial blood gases were monitored periodically for 24 hours after surgery. If required, tenoxicam (20-mg IV bolus) was used to ensure a VAS score of ≤3. The number of times PCEA and tenoxicam were administered and the occurrence of adverse events (AEs) were also recorded.Results: Sixty patients (34 men, 26 women; mean [SD] age, 75.96 [4.25] years; mean [SD] weight, 74.13 [10.62] kg) were included in the study. VAS scores were significantly lower in the dexmedetomidine group compared with the control group at hours 1, 2, and 12 (VAS [hour 1]: 2.8 [0.4], P < 0.001; VAS [hour 2]: 2.7 [0.5], P < 0.001; and VAS [hour 12]: 0.9 [0.7], P 0.044). The mean number of administrations of fentanyl via PCEA was significantly greater in the control group compared with the dexmedetomidine group (2.20 vs 6.63 times; P < 0.001). The mean number of administrations of tenoxicam was significantly lower in the treatment group than the control group (0.27 vs 1.07 times; P < 0.001). In the control group, the decreases in sedation at 0, 8, 12, 16, and 20 hours were significant compared with baseline (P = 0.024, P = 0.001, P = 0.020, P < 0.001, and P = 0.005, respectively). Mean HR, SBR and AEs (eg, bradycardia [HR <60 beats/min], respiratory depression [respiratory rate <8 breaths/min], hypotension \SBP <90 mm Hg], oversedation, hypoxia, and hypercapnia) decreased significantly in the dexmedetomidine group (all, P < 0.05). Significantly more patients in the dexmedetomidine group rated their satisfaction with postoperative pain control as excellent compared with the control group (12 vs 6 patients; P = 0.014).Conclusion: Intravenous dexmedetomidine was effective and generally well tolerated as an analgesic adjunct to epidural low-dose bupivacaine infusion for pain treatment, with lower need for opioids after abdominal surgery in these elderly intensive care patients than in the control group.     

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。     

酒石酸布托啡诺与芬太尼联合用于妇科患者术后静脉自控镇痛的临床研究

目的观察酒石酸布托啡诺与芬太尼合用于术后静脉自控镇痛(PCIA)的效果及最佳混合比例。方法 2010年8月-2011年1月100例妇科手术患者,随机分为5组,每组20例。均全身麻醉术后采用负荷量+持续背景剂量+PCIA方案镇痛。根据不同配方分为F组:芬太尼1 mg+生理盐水至100 mL;B组:酒石酸布托啡诺10 mg+生理盐水至100 mL;BFⅠ组:芬太尼0.6 mg+酒石酸布托啡诺3 mg+生理盐水至90 mL;BFⅡ组:芬太尼0.5 mg+酒石酸布托啡诺5 mg+生理盐水至100 mL;BFⅢ组:芬太尼0.3 mg+酒石酸布托啡诺6 mg+生理盐水至90 mL。观察术后各时点视觉模拟评分(VAS)及镇静评分,患者满意度以及不良反应情况。结果术后早期BFⅢ组和B组VAS评分大于F组;镇静评分B组大于F组;B组满意度优良率小于其余各组;恶心呕吐发生率F组高于BFⅠ组及BFⅡ组。结论酒石酸布托啡诺和芬太尼合用于PCIA,镇痛效果确切,不良反应发生率低。推荐配比:BFⅠ组和BFⅡ组。     

舒芬太尼复合罗哌卡因用于开胸术后硬膜外镇痛的疗效

【目的】观察舒芬太尼或芬太尼复合罗哌卡因用于开胸手术后硬膜外自控镇痛（PCEA）的临床镇痛效果和安全性。【方法】ASAⅠ～Ⅱ级,全麻复合连续硬膜外阻滞麻醉行开胸手术病人70例,随机分为两组（n=35）,使用0．75μg／ml舒芬太尼（S组）或3μg／ml芬太尼（F组）复合0．125％罗哌卡因,术后行PCEA。镇痛泵设定持续背景剂量2mL／h、PCA每次0．5mL,锁定时间15min。观察病人术后镇痛效果,记录术后4h、8h、12h、24h、48h各时间点的疼痛评分（VAS）、镇静评分、PCA使用次数、不良反应和病人满意度。【结果】S组术后8h、24h和48hVAS评分明显低于F组（P〈0．05）;S组各时间点镇静评分均明显大于F组（P〈0．05）;S组PCA按压次数显著低于F组（P〈0．05）;S组病人对PCA的满意度明显高于F组（P〈0．05）。两组恶心、呕吐发生率低,呼吸抑制相比无明显差异。【结论】舒芬太尼复合罗哌卡因用于开胸手术后PCEA,镇痛安全有效,镇痛镇静效果优于芬太尼,不良反应程度较轻。     

PCEA治疗带状疱疹后神经痛的临床观察

目的观察病人自控性硬膜外连续泵入（PCEA）布比卡因复合芬太尼治疗带状疱疹后神经痛（PHN）患者的治疗效果。方法我科采用PCEA泵入布比卡因复合芬太尼对症治疗，泵内加入镇痛药液：0．25％布比卡因200ml复合1μg/ml芬太尼，观察疗效。结果PCEA泵入布比卡因复合芬太尼对症治疗取得了较满意的疗效，总有效率为91．18％，并未发生严重并发症。结论PCEA布比卡因复合芬太尼治疗PHN疗效显著，操作简单、安全、患者使用方便。应熟练掌握操作技术，尽可能减少并发症的发生，降低复发率。     

地塞米松用于硬膜外术后镇痛临床观察

目的比较地塞米松和氟哌利多对剖宫产硬膜外术后镇痛的效果。方法120例剖宫产,分为3组行硬膜外术后镇痛,每组40例。A组:曲马多600 mg 布比卡因125 mg 地塞米松10 mg;B组:曲马多600 mg 布比卡因125 mg 氟哌利多5 mg;C组:曲马多600 mg 布比卡因125 mg。每组药液以生理盐水稀释至100 m l配成泵液。以视觉模拟评分法(VAS)评价镇痛效果,并观察不良反应,记录患者自控硬膜外镇痛(PCEA)按压次数。结果3组患者VAS评分、PCEA按压次数差异无显著性意义,但A组低于B、C组;恶心、呕吐发生率C组高于A、B组;瘙痒发生率A组低于B、C组;嗜睡发生率B组高于A、C组。结论地塞米松用于剖宫产术后镇痛预防恶心、呕吐、瘙痒有效,不良反应少。     

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.     

Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery

This study investigated whether the addition of 25 microg fentanyl to an ultra-low (sub-anaesthetic) dose of intrathecal bupivacaine provides adequate anaesthesia for out-patient anorectal surgery, without increasing side-effects or delaying hospital discharge. Patients were randomly allocated to receive 2.5 mg 0.5% bupivacaine plus 25 microg fentanyl (group BF, n = 18) or 5 mg 0.5% bupivacaine alone (group B, n = 17). There were no significant differences in intra-operative outcomes, but mean recovery and discharge times were significantly shorter in group BF. There were no between-group differences in hypotension, bradycardia or respiratory depression and post-operative complications were comparable, apart from pruritus which was significantly more frequent in group BF. Fewer patients requested analgesic medication in the early post-operative period in group BF than in group B. In conclusion, 25 microg intrathecal fentanyl added to ultra-low dose (2.5 mg) bupivacaine provided good-quality spinal anaesthesia and reduced post-operative analgesic requirement in patients undergoing ambulatory anorectal surgery.     

瑞芬太尼在机械通气患者镇痛镇静中的应用研究

目的观察瑞芬太尼对重症加强医疗病房(Intensive Care Unit,ICU)机械通气患者镇痛、镇静的临床疗效及不良反应。方法选择2017年12月1日至2019年12月25日在甘肃医学院附属医院(原平凉市人民医院)ICU拟行有创机械通气的106名患者,按随机数字表法分为芬太尼组(53例)及瑞芬太尼组(53例),分别给予芬太尼和瑞芬太尼持续静脉泵入镇痛、镇静。两组患者在治疗期间分别记录两组用药前后的CPOT、RASS和MAP、HR、SpO2,用药后的不良反应及谵妄发生情况。结果用药30min时芬太尼组MAP明显高于瑞芬太尼组,用药30min和60min时瑞芬太尼组的HR低于芬太尼组(P<0.05),其余生命体征无明显差异。芬太尼组用药30min时CPOT明显高于瑞芬太尼组(P<0.05),其余时间点镇痛、镇静深度差异无统计学意义。瑞芬太尼组患者谵妄、呕吐发生率较芬太尼组减少(P<0.05),两组恶心发生率无明显差异(P>0.05)。结论瑞芬太尼用于ICU机械通气患者与经典治疗效果相当,且起效迅速,能缩短机械通气时间,减少镇静剂的用量,从而在一定程度上减少谵妄的发生。     

术后芬太尼皮下镇痛及对胃肠功能影响的研究

目的 比较术后芬太尼皮下镇痛(PCSA)与硬膜外镇痛(PCEA)的临床效果,以及对胃肠功能的影响.方法 2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例,术后分别实施PCSA与PCEA,观察术后第4、8、12、24、48 h的镇痛、镇静情况,呼吸循环、恶心呕吐及其他不良事件,记录术后首次肛门排气时间,...     

Epidural Labor Analgesia: Continuous Infusion Versus Patient-Controlled Epidural Analgesia With Background Infusion Versus Without a Background Infusion

The purpose of this study was to compare the total epidural dose of 3 commonly used labor epidural modalities. After local institutional review board approval, 195 laboring parturients received an epidural catheter for labor analgesia. All patients received an initial bolus of 0.1% ropivacaine (10 mL) and fentanyl (100 microg). Maintenance of labor analgesia consisted of ropivacaine 0.1% with fentanyl 2 microg/mL. Patients were then randomly assigned into 3 groups: Group 1 (continuous epidural infusion [CEI]), continuous infusion at 10 mL/h; group 2 (CEI + patient-controlled epidural analgesia [PCEA]), CEI at 5 mL/h with a demand dose of 5 mL allowed every 20 minutes with a 20 mL/h maximum dose; group 3 (PCEA), demand doses only of 5 mL every 15 minutes with a 20 mL/h maximum dose. Measured variables included total epidural dose, total bolus requests and boluses delivered, number of staff interventions, pain Visual Analog Scale (VAS; 0-100), modified Bromage scores, stage I and II labor duration, delivery outcome, and maternal satisfaction after delivery. No differences were noted with respect to pain VAS, modified Bromage scores, stage I and II labor duration, number of staff interventions, delivery outcome, and maternal satisfaction score. Total infusion dose was lower in demand dose only PCEA compared with CEI and CEI + PCEA groups (P = < .01). Demand dose-only PCEA results in less total epidural dose compared with CEI and CEI + PCEA without affecting labor duration, motor block, pain VAS, maternal and neonatal outcomes, and maternal satisfaction. PERSPECTIVE: This article compares 3 commonly used labor epidural delivery modalities (traditional continuous epidural infusion, patient-controlled epidural analgesia with a background infusion, and demand dose-only patient-controlled epidural analgesia). Benefits in epidural dose reduction with demand dose only PCEA does not translate into improved maternal and neonatal outcome.     

小剂量氯胺酮辅助吗啡自控镇痛治疗晚期癌痛的临床研究

目的:观察小剂量氯胺酮辅助吗啡硬膜外、静脉或皮下自控镇痛用于顽固性中、重度晚期癌痛患者的可行性及止痛效果。方法:选择78例中、重度晚期癌痛患者,均为虽经三阶梯药物治疗方案治疗未能很好地控制疼痛,同时毒副作用较大的患者。按是否可以行硬膜外穿刺置管分成三组,硬膜外自控镇痛(patient controlled epidural analgesia,PCEA)组(n=28例)、静脉自控镇痛(patient controlled intravenous analgesia,PCIA)组(n=24例)和皮下自控镇痛(patient controlled skinanalgesia,PCSA)组(n=26例)。采用硬膜外自控镇痛组,镇痛液为200 ml,内含吗啡20 mg+氯胺酮100 mg。静脉和皮下自控镇痛组200 ml内含吗啡80 mg+氯胺酮400 mg。分别在安装止痛泵后24小时、48小时采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度,统计两组不良反应的发生率。结果:经治疗,三组病例疼痛明显缓解。三组间视觉模拟评分各时段无统计学差异(P>0.05)。吗啡和氯胺酮用量PCIA组和PCSA组明显多于PCEA组。PCEA组生活总满意度明显高于PCIA组和PCSA组。恶心呕吐、便秘、嗜睡、皮肤瘙痒、尿潴留PCIA组和PCSA组明显高于PCEA组。呼吸抑制、幻觉发生率三组无差异。结论:本研究结果表明,小剂量氯胺酮辅助吗啡硬膜外、静脉或皮下自控镇痛都可以有效治疗中/重度晚期顽固性癌痛。经硬膜外小剂量氯胺酮辅助吗啡自控镇痛具有镇痛作用强、用药量少、副作用小等优点。     

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。     

小儿尿道下裂修补术后硬膜外自控镇痛与静脉自控镇痛的效果观察

目的比较盐酸曲马多＋岁哌卡因硬膜外白控镇痛与盐酸曲马多＋芬太尼静脉白控镇痛用于小儿尿道下裂修补术后的效果及不良反应。方法60例ASAI～II级、年龄3～8岁的尿道下裂患儿,随机分为两组,每组30例。A组（n=30）：盐酸曲马多＋罗哌卡因硬膜外自控镇痛（PCEA）,术毕前30min硬膜外给予盐酸曲马多0．5mg／kg＋0．125％罗哌卡因3m1,术毕盐酸曲马多1rag／kg＋氟哌利多0．05mg／kg＋0．125％布比卡因,加生理盐水至100ml,持续泵入1ml／h,PCA 1ml／次,锁定时间为10min;B组（n=30）：盐酸曲马多＋芬太尼静脉白控镇痛（PCIA）,盐酸曲马多1mg／kg＋芬太尼0．001mg／kg＋氟哌利多0．05mg／kg,加生理盐水至100ml,术毕静脉泵入1ml／h,PCA 1ml／次,锁定时间10min。观察术后采用视觉模拟评分（VAS）分别记录两组术后1h、3h、6h、12h、24h、48h的镇痛效果,同时记录心率、血氧饱和度及不良反应的发生率。结果A、B组的VAS评分、心率无明显差异（P〉0．05）;B组在术后1h、3h血氧饱和度明显低于A组（P〈0．05）,在其他时间与A组无明显差异（P〉0．05）;B组有5例嗜睡,6例出现轻度恶心呕吐（P〈0．01）。结论小儿尿道下裂术后PCEA与PCIA的效果相当,但PCIA的副作用稍大,PCEA更合适。     

三种镇痛方法对胸部术后镇痛效果和通气功能影响的比较

目的:比较静脉、硬膜外及肋间神经阻滞合并静脉3种镇痛方法用于胸部手术后的镇痛效果及其对通气功能的影响。方法:45例择期开胸手术患者随机数字表法分为静脉镇痛组(Ⅰ组)、肋间神经阻滞合并静脉镇痛组(II组)及硬膜外镇痛组(Ⅲ组)。术后镇痛:Ⅰ组持续以2.5mL/h静脉泵入芬太尼(15mg/L)+咪唑安定(0.3g/L);Ⅱ组关胸前以2.5g/L布比卡因行切口及上下各2个肋间的肋间神经阻滞,术后以2.5mL/h持续静脉泵入芬太尼(10mg/L)+咪达唑仑(咪唑安定)(0.3g/L);Ⅲ组以2.5mL/h持续硬膜外泵入1.8g/L布比卡因+芬太尼(3mg/L)+咪唑安定(0.2g/L)。患者术后以视觉模拟评分法行痛觉评分(VAS);测量心率、平均动脉压、动脉血氧分压(PaO2)及二氧化碳分压(PaCO2);测定用力肺活量和第一秒用力呼出气量(FEV1)。结果:Ⅰ组术后3h及6hVAS明显高于Ⅱ组(P<0.05),术后0,3,6,12hVAS明显高于Ⅲ组(P<0.05,0.01);Ⅱ组术后12hVAS明显高于Ⅲ组(P<0.05);Ⅱ组术后3,6hFVC及FEV1显著高于Ⅰ组(P<0.01,0.05);Ⅲ组患者术后3hFVC、术后6,12hFVC和FEV1及术后24hFEV1显著高于Ⅰ组(P<0.05);Ⅰ组患者术后0h的PaO2明显低于另外二组(P<0.05),而其PaCO2明显高于Ⅲ组(P<0.05)。结论:硬膜外输注布比卡因和芬太尼或肋间神经阻滞合并静注芬太尼用作开胸手术患者的术后镇     

Ropivacaine/Fentanyl vs. Bupivacaine/Fentanyl for Pain Control in Children after Thoracic Surgery: A Randomized Study

BackgroundAlthough bupivacaine remains a standard local anesthetic for postoperative epidural infusions in pediatric patients, it is increasingly being replaced with ropivacaine by many anesthesiologists. Ropivacaine is associated with less risk for cardiac and central nervous system toxicity.AimsThe purpose of this study was to compare analgesic efficacy and adverse events of postoperative epidural analgesia with ropivacaine/fentanyl versus bupivacaine/fentanyl in children after the Ravitch procedure and thoracotomy.DesignThis was a prospective randomized controlled study.SettingsThis study was conducted at the Department of Thoracic Surgery of the Institute of Tuberculosis and Lung Diseases in Rabka Zdroj, Poland.Participants/Subjects94 patients undergoing elective thoracic surgery.MethodsPatients aged 7-17 years were randomly allocated into a ropivacaine 0.2% (RF, n = 45) or bupivacaine 0.125% (BF, n = 45) group; 1 mL of each analgesic solution contained 5 μg fentanyl. All patients received acetaminophen and nonsteroidal anti-inflammatory drugs. Nurses assessed pain intensity and incidence of adverse events over 72 hours after surgery and modified analgesia if patient pain intensity was greater than 2 out of 10.ResultsThere was no statistically significant difference in median pain scores and incidence of adverse events between the RF group and the BF group. The analgesia was excellent (median pain intensity scores at rest, during deep breathing, and when coughing was less than 1 out of 10 in all patients). Adverse events included incidents of desaturation (64/90), nausea (18/90), vomiting (31/90), pruritus (12/90), urinary retention (2/90), paresthesia (11/90), anisocoria (2/90), and Horner syndrome (2/90).ConclusionsThoracic epidural analgesia using an RF and BF solution resulted in similar pain relief and adverse event profiles.     

帕瑞昔布钠联合芬太尼用于胸部手术后镇痛效果观察

【目的】观察帕瑞昔布钠联合芬太尼在胸科手术后的镇痛效果。【方法】选择ASAI～Ⅱ级需行食管癌或贲门癌手术患者40例,随机分成帕瑞昔布钠联合芬太尼（P组）和单纯芬太尼组（F组）,每组各20例。于手术结束前30min,P组静注帕瑞昔布钠40mg,F组静注生理盐水4mL。术后均采用芬太尼自控静脉镇痛（PCIA）。记录术后2h、4h、12h和24h两组VAs评分、镇静评分,术后24h两组PCA按压总次数和有效次数,芬太尼的用量及不良反应。【结果】术后2h、4h、12h和24hVAS评分,术后24hPCA按压总次数和有效次数,芬太尼的用量P组均明显少于F组（P〈0．05）;术后24h出现恶心、呕吐、嗜睡的患者例数P组也少于F组（P〈O．05）。【结论】帕瑞昔布钠联合芬太尼用于胸科手术后PCIA镇痛效果更好,能减少术后芬太尼的用量,降低芬太尼所致不良反应的发生率。     

冠心病非心脏手术后不同镇痛方法对心肌缺血的影响

目的：观察冠心病（CHD）患者非心脏手术后不同镇痛模式对其心肌缺血（MI）的影响。方法：将CHD术后患者分成三组，硬膜外自控镇痛（PCEA）组、肌注组和对照组。以动态心电图（DCG）监测CHD非心脏手术患者169例，术后监测至少48h。记录术后MI发生率、平均每小时MI次数、MI持续时间、MI曲线下面积以及VAS评分。结果：PCEA组镇痛效果好，并且可以有效地降低术后MI发生率、平均每小时M1次数、MI时间以及MI曲线下面积，与其它两组比较有显著性差异（P〈0．01）。结论：术后完善的镇痛很有必要，可以减少CHD患者非心脏手术后MI的发生。