硬膜外布比卡因-咪唑安定或/和曲马多用于术后镇痛

目的：观察咪唑安定或／和曲马多在术后镇痛中的作用。方法：分别于硬膜外注入布比卡因（对照组,Ⅰ组,ｎ＝２０）,布比卡因和咪唑安定（Ⅱ组,ｎ＝２５）,布比卡因和曲马多（Ⅲ组,ｎ＝２５）及布比卡因,咪唑安定和曲马多（Ⅳ组,ｎ＝２５）,比较术后镇痛效果,结果：布比卡因－咪唑安定具有罗好的术后镇痛效果。布比卡因加用咪唑安定和曲马多联用可提供更好的术后镇痛作用,并可明显减少阿片类药物用量。加用咪唑安定后主要副     

硬膜外腔罗哌卡因加曲马多及布比卡因加曲马多用于子宫切除术后镇痛的比较

硬膜外腔低浓度布比卡因加阿片类镇痛药可有效地减轻术后疼痛。然而,完善镇痛所需的布比卡因浓度会引起运动障碍,增加阿片类镇痛药剂量则又有尿潴留、呼吸抑制等顾虑。罗哌卡因具有明显的感觉-运动分离阻滞的特性。本文用罗哌卡因和曲马多分别替代布比卡因和阿片类镇痛剂,观察子宫切除术后硬膜外腔应用罗哌卡因与曲马多行术后     

新斯的明硬膜外镇痛

目的 探讨新斯的明硬膜外腔注入用于手术后镇痛的剂量依赖性。方法 60例子宫肌瘤切除术或卵巢肿瘤切除术的患者随机分为六组，每组10例，于硬膜外麻醉手术结束时硬膜外腔分别注入新斯的明0.5、1、2或3mg，每组均加东莨菪碱0.3mg和布比卡因0.15mg。测定术后镇痛时间与镇痛强度，并与生理盐水组和0.15mg布比卡因组作比较，结果 新斯的明0.5mg组镇痛时间与镇痛强度不如1mg组（P＜0.05），2mg组和3mg组镇痛时间与镇痛强度与1mg组无明显差异（P＞0.05），生理盐水对照组与布比卡因对照组则无镇痛作用。结论 硬膜外腔注入新斯的明、东莨菪碱、布比卡因混合液，可产生非剂量依赖性镇痛效应。     

布比卡因－吗啡混合液硬膜外腔注射用于术后控制重度妊娠高血压综合征的观察

布比卡因－吗啡混合液硬膜外腔注射用于术后控制重度妊娠高血压综合征的观察王志刚，应诗达，王秀光近三年期间我科对１５例重度妊娠高血压综合征（下简称妊高征）剖宫产术后，经硬膜外腔注射布比卡因吗啡混合液施行持续４８ｈ镇痛、降压治疗，效果较满意，现报告如下。资...     

布比卡因芬太尼不同稀释液对术后硬膜外镇痛的观察

布比卡因芬太尼不同稀释液对术后硬膜外镇痛的观察樊长川，崔道矩硬膜外麻醉６０例，术后随机分两组，其性别、年龄、ＡＳＡ组间无显著差异。待诉述伤口疼痛，即经硬膜外导管注入混合液（布比卡因３０ｍｇ，芬太尼０．１ｍｇ；Ａ组加６％低分子右旋糖酐溶液至２０ｍｌ；Ｂ...     

术后硬膜外腔持续注入布比卡因-芬太尼镇痛效果优于吗啡单次注入法

对硬膜外腔吗啡(Mo)单次注入法与布比卡因(Bu)-芬太尼(Fe)混合液持续注入法术后镇痛效果、舒适程度、副作用等作了对比观察。对象与方法:选择无支气管哮喘、ASAⅠ～Ⅲ级,12～81(57.4±12.7)岁的上腹部手术病人100例。男63例,女37例。随机分为Mo单次硬膜外注入(M-S     

微量吗啡与布比卡因混合液用于硬膜外术后镇痛（附80例分析）

微量吗啡与布比卡因混合液用于硬膜外术后镇痛（附８０例分析）林尔美，蔡丽燕，林绍立椎管内吗啡镇痛副作用较多，为探求镇痛效果满意、副作用小的术后镇痛方法，我们从１９９２年５月起试用硬膜外注射微量吗啡与布比卡因混合液，现报道如下。临床资料选硬膜外阻滞完善、...     

盐酸丁卡因用于胸科手术后硬膜外镇痛的临床观察

笔者对全麻下开胸肺叶切除术病人，用盐酸丁卡因施行硬膜外腔术后镇痛，收到良好效果。现总结报告如下。１资料与方法１．１镇痛方法：选择择期全麻下开胸行肺叶切除术病人，随机分为丁卡因组和布比卡因组，每组２０例。ASAI－Ⅱ级，年龄４２～６５岁，入室后全麻诱导前，经T６－７或T７－８椎间隙穿刺置入硬膜外导管，并注入２％利多卡因５ml；以针刺法测定平面，确认导管在硬膜外腔后，开始全麻诱导行气管内插管全身麻醉。术毕关胸时，丁卡因组从硬膜外导管注入０．１５％丁卡因１０ml布比卡因组从硬膜外导管注入０．１５％布比卡因１…     

硬膜外布比卡因加地塞米松术后镇痛的临床应用

我们将布比卡因加地塞米松硬膜外腔注射作为术后镇痛 ,试图增强效果 ,报道如下。资料与方法选择硬膜外麻醉下手术病人 10 0例 ,随机分为四组 ,每组 2 5例。术毕硬膜外腔注入不同药物 ,组Ａ :0 75 %布比卡因 6ｍｌ和地塞米松 1ｍｌ(5ｍｇ) ;组Ｂ :0 75 %布比卡因 6ｍｌ和生理盐水 1ｍｌ;组Ｃ :0 75 %布比卡因 6ｍｌ和生理盐水 1ｍｌ,并静注地塞米松 1ｍｌ(5ｍｇ) ;组Ｄ :吗啡 2ｍｇ、氟哌啶 2 5ｍｇ、布比卡因 30ｍｇ和生理盐水混合液 7ｍｌ。全组术前 30分钟肌注安定 10ｍｇ ,根据手术需要选择硬膜外穿刺点 ,局麻药用利多卡因和布比卡因…     

耻骨上前列腺切除术后并发症的防治

目的：探讨耻骨上前列腺切除术后常见出血,尿失禁、前列腺窝品狭窄和膀胱无抑制痉挛４种并发症的原因及防止方法,方法：采用窝品周圈深“８”字环扎血管及术皇导尿管牵拉压迫或术中经尿道电切镜电灼术;术中避免损伤胱外括约肌;缝合窝口时不缩紧,保证可容２指大小;术后由骶管内持续注入０．１２５％布比卡因,结果：采用以上措施经治１０９例患者,取得较好的临床效果,与经典的耻骨上前列腺切除术相比,术后并发症的发生率明显     

前列腺切除术后静脉自控镇痛与连续硬脊膜外腔镇痛治疗的疗效观察

目的：探讨静脉吗啡自控镇痛（PCIA）与连续硬脊膜外腔吗啡镇痛（CEIA）对前列腺切除术后镇痛效果和安全性。方法：60例前列腺切除术后患者随机分成PCIA组、CEIA组及对照组各20例。CEIA组持续性经硬脊膜外腔导管注入吗啡0．08mg/h;PICA组在术后经静脉持续给吗啡2．0mg/h,患者疼痛时自行追加吗啡1．0mg/次,锁定时间20min;对照组出现时疼痛时肌肉注射度冷丁50mg或其他解痉镇痛药。采用视觉模拟评分（VAS）法观察各组测道评分,记录各组患者膀胱痉挛次数及持续时间、停止冲洗时间等。结果：PCIA与CEIA两组与对照组相比具有镇痛效果显著、膀胱痉挛次数少、疼痛持续时间短的优点（P＜0．001）;PCIA与CEIA两组相比上述指标差异无显著性意义,但剂量及不良反应的差异有显著性意义（P＜0．05）;术后康复指标各组间差异无显著性意义。结论：吗啡PCIA及CEIA给药对前列腺切除术后患者镇痛效果良好,但对因血凝块引起的膀胱痉挛性疼痛均无效。从镇痛效果及不良反应等综合因素评估以CEIA为优。     

硬膜外连续注射曲马多对血中ACTH,皮质醇浓度的影响

选择３０例上腹部手术患者，分别肌注止痛药、硬膜外间断注射曲马多和硬膜外连续注射曲马多进行术后镇痛，根据ＶＡＳ评分结果，表明术后镇痛效果硬膜外连续注射曲马多优于间断注射，并优于肌注止痛药。通过测定围术期血中ＡＣＴＨ和皮质醇浓度，表明硬膜外注射曲马多镇痛可明显减轻术后ＡＣＴＨ的过度分泌，连续硬膜外注射曲马多镇痛可有效地减轻术后皮质醇的升高，提示硬膜外连续注射曲马多术后镇痛，可有效地控制上腹部手术后的皮质醇和ＡＣＴＨ的反应。     

醋氯芬酸与曲马多对经尿道前列腺电切术后膀胱痉挛性疼痛的疗效与安全性分析

目的 比较分析醋氯芬酸与曲马多对经尿道前列腺电切术(transurethral resection ofthe prostate,TURP)后患者膀胱痉挛性疼痛的疗效与安全性.方法 选择196例于本院泌尿外科就诊的前列腺增生患者作为研究对象,随机分为两组,每组98例,A组术后给予醋氯芬酸分散片;B组术后给予曲马多缓释片.比较两组患者术后24h内VAS评分、膀胱痉挛出现的次数与持续时间及药物不良反应发生情况.结果 两组患者术后24h内各时间节点的VAS评分、膀胱痉挛出现的次数与持续时间差异无统计学意义(P＞0.05).B组患者恶心、眩晕、头痛、精神不振及发热等不良反应发生率明显高于A组(P＜0.05).结论 醋氯芬酸与曲马多对经TURP术后患者膀胱痉挛性疼痛的疗效相当,醋氯芬酸的安全性相对较高.     

The influence of a bupivacaine and fentanyl epidural infusion after epidural fentanyl in patients allowed to ambulate in early labor

Epidural fentanyl after a lidocaine and epinephrine test dose provides adequate analgesia and allows for ambulation during early labor. This study was designed to determine the influence of an epidural infusion of bupivacaine plus fentanyl administered after initiation of epidural labor analgesia with fentanyl. Specifically, we evaluated whether there is an increase in motor block or an increased time to request for further analgesic medication. Fifty-one laboring primigravid women at <5 cm cervical dilation who requested epidural analgesia were enrolled. After a 3-mL epidural test dose of 1.5% lidocaine with epinephrine (5 microg/mL), patients received fentanyl 100 microg via the epidural catheter. They then randomly received either an infusion (10 mL/h) of 0.0625% bupivacaine with fentanyl (3 microg/mL) or an infusion of preservative-free saline. After the administration of the initial analgesic, pain scores and side effects were recorded for each patient at 10, 20, and 30 min, every 30 min thereafter, and at the time of request for additional analgesic medication, by an observer blinded to the technique used. There were no demographic differences between the two groups. The mean duration of analgesia (time from initial dose to request for additional analgesia) was increased in the group that received a continuous infusion of bupivacaine and fentanyl compared with the Saline group (198 +/- 86 vs 145 +/- 50 min; P < 0.009). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block. Fourteen patients chose to ambulate in the Saline group, and 12 patients chose to ambulate in the Infusion group. In early laboring patients, a continuous infusion of 0.0625% bupivacaine infusion with fentanyl (3 microg/mL) prolonged the duration until top-up was required, after epidural fentanyl 100 microg after a lidocaine and epinephrine test dose, and did not cause any clinically detectable motor block. IMPLICATIONS: A 0.0625% bupivacaine and fentanyl (3 microg/mL) infusion, when added to epidural fentanyl (100 microg), prolongs the analgesic duration without increasing motor block in women in early labor.     

Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain

We compared the efficacy of intravenous patient controlled analgesia of buprenorphine plus continuous thoracic epidural infusion of bupivacaine (IV-PCA group) with the efficacy of continuous thoracic epidural infusion of bupivacaine and buprenorphine (the TEA group). No patient in IV-PCA group required supplemental analgesics, while 90% of TEA group required supplemental intramuscular buprenorphine to relieve post-thoracotomy pain. In TEA group, 94% of the supplemental drugs were administered during night shifts. These results indicate that IV-PCA of buprenorphine combined with continuous thoracic epidural infusion of bupivacaine is more effective analgesic management than continuous TEA with buprenorphine and bupivacaine.     

前列腺切除术后应用PCEA预防继发性出血的观察

目的 :探讨病人自控镇痛PCEA预防前列腺切除术后继发性出血的效果和安全性。　方法 :60例前列腺切除术后患者随机分成PCEA组 ,对照组各 3 0例 ,PCEA组经硬外导管与PCA微量泵相连 ,连续给药 ,对照组出现疼痛时肌肉注射度冷丁 5 0mg或其他解痉镇痛药 ,记录各组患者血尿情况 ,停止冲洗时间等。　结果 :PCEA组与对照组相比具有镇痛效果显著、冲洗时间短、出血明显减少的优点。　结论 :PCEA对前列腺切除术后预防继发性出血效果良好 ,安全可靠等优点     

Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine

The analgesic efficacy of the continuous epidural infusion of 0.0625% bupivacaine/0.0002% fentanyl was compared with the infusion of 0.125% bupivacaine alone in a randomized, double-blind study of nulliparous women. Each patient received, in sequence: 1) 3 ml of 0.5% bupivacaine with 1:200,000 epinephrine; 2) 6 ml of study solution 1 (bupivacaine-fentanyl group: 0.125% bupivacaine/0.0008% fentanyl; bupivacaine-only group: 0.25% bupivacaine alone); and 3) a continuous epidural infusion of study solution 2 at a rate of 12.5 ml/h (bupivacaine-fentanyl group: 0.0625% bupivacaine/0.0002% fentanyl; bupivacaine-only group: 0.125% bupivacaine alone). The epidural infusion was discontinued at full cervical dilatation, but patients who lacked perineal anesthesia received one or two 5-ml boluses of study solution 3 (bupivacaine-fentanyl group: 0.0625% bupivacaine alone; bupivacaine-only group: 0.125% bupivacaine alone). During the first stage of labor, 36 of 41 (88%) women in the bupivacaine-fentanyl group, and 37 of 39 (95%) women in the bupivacaine-only group, had analgesia of excellent or good quality (P = NS). During the second stage, 22 of 37 (59%) women in the bupivacaine-fentanyl group, and 23 of 35 (66%) women in the bupivacaine-only group, rated their analgesia as excellent or good (P = NS). Women in the bupivacaine-only group were more likely to have motor block at full cervical dilatation (P less than .001). There was no significant difference between groups in duration of the second stage of labor, duration of pushing, position of the vertex before delivery, method of delivery, Apgar scores, or umbilical cord blood gas and acid-base values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative analgesia using continuous lumbar epidural infusion of ropivacaine in comparison with bupivacaine

BACKGROUND: Epidural bupivacaine infusion is a commonly used technique for postoperative analgesia because of its motor-sparing properties. Recently a new long acting local anesthetic, ropivacaine, has become available. The aim of this study was to investigate the efficacy of ropivacaine and bupivacaine with regard to postoperative analgesia when administered continuously into the lumbar epidural space. METHODS: All patients were ASA I II and undergoing ipsi-lateral leg orthopedic surgery with epidural or combined spinal-epidural anesthesia. Patients were randomly assigned to following three groups: 0.1% ropivacaine (0.1 R); 0.2% ropivacaine (0.2 R); 0.125% bupivacaine (0.125 B). At the end of surgery, continuous infusion was begun at a rate of 6 ml.hr 1 after a bolus epidural administration of 5 ml of 0.2% ropivacaine in R groups and 0.25% bupivacaine in B group. Sensory and motor block, blood pressure, pulse rate, verbal pain score (VPS), analgesic consumption were assessed at 20 min, 1, 3, 10-20 hrs following the beginning of continuous infusion. RESULTS: Vital signs were stable at every measuring point in all groups. In 0.1 R group (n = 20), the spread of sensory block at 3 hrs after infusion was lower than 0.2 R group (n = 19), and VPS during the study was higher than 0.125 B group (n = 17). Bromage scale after 3 hrs was higher in 0.2 R group compared with 0.125 B group. The degree of sensory and motor block gradually decreased, resulting in little difference between the groups. When epidural anesthesia was spread over the surgical area throughout the study, 0.2 R or 0.125 B was sufficiently relieved from postoperative pain. CONCLUSIONS: After leg orthopedic surgery, 6 ml.hr-1 of 0.2 R or 0.125 B provided enough postoperative analgesia when the spread of anesthesia covered the operated area. 0.2 R would be better compared to 0.125 B in continuous epidural infusion for postoperative analgesia due to less systemic toxicity, even though it accompanies a little more intense motor block.     

Efficacy of the fascia iliaca compartment block vs continuous epidural infusion for analgesia following total knee replacement surgery

Background and objective: Total knee replacement causes moderate to severe postoperative pain. The aim of this trial was to compare postoperative analgesia from a fascia iliaca compartment block to continuous epidural analgesia following knee arthroplasty. Patients and Methods: Clinical trial enrolling patients in American Society of Anesthesiologists (ASA) classes 1 to 3 randomized to 2 groups. One group received spinal anesthesia plus a fascia iliaca compartment block with 0.1% bupivacaine at a rate of 10 mL/h. The second group received combined spinal-epidural anesthesia plus epidural analgesia with 0.1% bupivacaine in continuous infusion at a rate of 8 mL/h. Postoperative pain on a visual analog scale (VAS) at rest and on movement was recorded every 3 hours for the first 24 hours. Use of intravenous morphine and the adverse events were also recorded. Results: Forty patients (20 for each group) were enrolled. The distribution of age, weight, body mass index, sex, ASA class, duration of surgery, use of morphine, and the incidence of adverse effects were similar in the 2 groups. Postoperative VAS scores at rest and on movement were also similar. The incidence of arterial hypotension was higher in the epidural analgesia group. Conclusions: The fascia iliaca compartment block and continuous epidural infusion are similarly efficient in providing postoperative analgesia for patients after total knee replacement. The fascia iliaca compartment block is associated with a lower incidence of postoperative hemodynamic complications. Early, safe rehabilitation is facilitated by both analgesic techniques.     

Epidural infusion of low dose bupivacaine after combined spinal-epidural anesthesia using needle through needle method provided no analgesic effect on postoperative pain after caesarian section

BACKGROUND: In order to evaluate the analgesic efficacy of low dose epidural bupivacaine infusion with and without morphine after caesarean section we performed combined spinal-epidural anesthesia (CSEA) using needle through needle method. Three different epidural analgesic regimens were compared retrospectively. METHODS: The number of analgesic use during 24 hours after operation was compared. Patients were categorized into three groups; group N : intraoperative bolus epidural morphine (2.5 mg) alone, group L : bolus morphine (2.5 mg) plus epidural bupivacaine infusion (32 ml of 0.2% bupivacaine) at a rate of 2.1 ml x hr(-1), group M : bolus morphine (2.4 mg) plus epidural bupivacaine-morphine (33 ml of 0.2% bupivacaine containing morphine 2.3 mg) infusion at a rate of 2.1 ml x hr(-1). Used analgesics included pentazocine 15 mg i.m., diclofenac 25 mg suppo. and loxoprofen 60 mg p.o.. RESULTS: The mean number of analgesic use during the first 24 hours in group M (0.29 +/- 0.46) was significantly smaller than those of group N (0.97 +/- 0.91) and group L (0.84 +/- 0.95). Percentage of patients requiring no analgesic during the first 24 hours was significantly less in group M (70.8%) than in group N (33.4%) and group L (42.1%). CONCLUSIONS: A 2.1 ml x hr(-1) infusion of epidural bupivacaine has no analgesic effect after caesarean section under CSEA using NTN method.