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.     

Efficacy of patient-controlled analgesia for management of pain after abdominal operations.

In order to control pain during the early post-operative period, patient-controlled analgesia (PCA) with buprenorphine as an analgesic drug was applied in 23 patients undergoing abdominal operations. With this "on demand" system, the patient was allowed to self-administer narcotic analgesic medication using a programmable infusion pump. Overdose could be minimized with a mandatory lock-out interval between allowable injections. Average total requirement of buprenorphine was 0.355 mg at 48 hr after operation. Nineteen of the 23 (82.6%) patients characterized their pain control as "excellent" or "good". In these patients there existed high correlation between the total number of patient attempts and the number of successful injections. The PCA system was thought to provide improved pain relief at smaller total drug dosages. In addition, earlier and greater spontaneous physical activity was maintained with PCA therapy. The potential for overdose could be minimized, and thereby PCA appears to be an efficacious and safe method of providing for postoperative pain relief.     

舒芬太尼与芬太尼复合罗哌卡因用于腹部手术后硬膜外镇痛的比较

目的:对比观察等效剂量的舒芬太尼与芬太尼复合罗哌卡因用于腹部手术后硬膜外镇痛的临床效果。方法:选择ASAⅠ～Ⅱ级,择期在硬膜外麻醉下行腹部手术的患者60例,随机分为两组(每组n=30),术后行患者自控硬膜外镇痛(PCEA)。参数设置为负荷剂量(5mL) 持续剂量(3mL/h) PCA剂量(2mL/次),锁定时间为30min。A组镇痛药物为0.2%罗哌卡因 0.4μg/mL舒芬太尼,B组为0.2%罗哌卡因 2μg/mL芬太尼。随机双盲对比观察术后4、8、12、24h内按压PCA的次数、视觉模拟评分(VAS)、舒适评分,并比较两组患者术后恶心、呕吐、嗜睡等不良反应的发生率及运动神经阻滞情况。结果:(1)两组患者年龄、体重等一般情况和术中局麻药用量无明显差异(P>0.05);(2)前24h内A组的PCA按压次数为(5.2±3.8)次,较B组(7.4±4.6)次明显减少(P<0.05),且A组在术后4、8、12、24h时疼痛评分均略低于B组(P<0.05);(3)术后12、24h舒适评分A组显著高于B组(P<0.05);(4)A组术后恶心、呕吐显著少于B组(P<0.05),嗜睡等不良反应的发生率在两组之间也没有明显差异(P>0.05)。结论:0.4μg/mL舒芬太尼和2μg/mL芬太尼复合0.2%罗哌卡因均可满足术后硬膜外镇痛的需要,但舒芬太尼的镇痛效果明显优于芬太尼。     

地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛的效果观察

目的 观察地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛的临床效果和不良反应.方法 美国麻醉医师协会(ASA)Ⅰ、Ⅱ级择期经腹子宫全切除术患者60例,按随机数字表分为两组,每组30例.地佐辛组给予地佐辛6 mg +0.75％盐酸罗哌卡因20 ml+生理盐水稀释至100 ml;吗啡组给予吗啡6 mg +0.75％盐酸罗哌卡因20ml+生理盐水稀释至100 ml,进行硬膜外术后镇痛.负荷剂量:地佐辛组为地佐辛2 mg+生理盐水稀释至5ml;吗啡组为吗啡2 mg+生理盐水稀释至5ml;持续剂量2 ml/h,单次给药剂量2ml,锁定时间15 min.全程镇痛48 h.采用视觉模拟评分法(VAS)评价术后不同时间点(4、8、12、24、36、48 h)的镇痛效果,并记录硬膜外术后镇痛中的不良反应.结果 两组患者镇痛效果总体满意,地佐辛组术后不同时间点VAS评分略低于吗啡组,术后不同时间点(4、8、12、24、36、48 h)VAS评分比较,地佐辛组[(2.7±0.4)、(2.5±0.6)、(2.2±0.5)、(1.5±0.5)、(1.3±0.5)、(1.1±0.3)分]略低于吗啡组[(2.8±0.5)、(2.6±0.7)、(2.3±0.6)、(1.6±0.7)、(1.5±0.6)、(1.2±0.4)分],但差异均无统计学意义(F组内=2414.96,P＜0.01;F组间=0.63,P＞0.05;F交互=2.42,P＞0.05);两组术后各时间点VAS评分比较,差异无统计学意义(P均＞0.05);组内术后12、24、36、48 h与术后4h时间点比较差异有统计学意义(P均＜0.01).地佐辛组恶心、呕吐及皮肤瘙痒的发生率[(3.3％(1/30)、0(0/30)]均低于吗啡组[26.7％(8/30)、20.0％ (6/30)],两组比较差异有统计学意义(P值分别为0.026、0.024).结论 地佐辛复合罗哌卡因用于经腹子宫全切除术后硬膜外镇痛安全有效、不良反应少,值得在临床中推广使用.     

胸部手术后硬膜外自控与静脉自控镇痛的效果比较

目的比较经硬膜外和经静脉在胸部手术后病人自控镇痛(PCA)的有效性和安全性。方法将72例在全麻下行胸部手术的患者随机分为经硬膜外镇痛组(PCEA组,36例)和经静脉镇痛组(PC IA组,36例),病人均于手术结束前30m in接PCA泵。PCA泵背景量2m l/h,PCA量0.5m l,锁定时间15m in。自控镇痛期间记录各时间点的疼痛程度(PI)(使用口述描绘5级评分法)和患者的舒适满意度(采用BCS模拟评分法),并记录发生的不良反应。结果PC IA组患者舒适满意度低于PCEA组,PC IA组不良反应高于PCEA组(P<0.05),两组病人并发症、镇痛效果无明显差异。结论胸部手术尤其开胸手术后PCEA镇痛的有效性和安全性高于PC IA,术后镇痛应以PCEA方法为主。     

硬膜外自控镇痛对妇科手术后镇痛效果观察及护理

目的了解硬膜外自控镇痛(PECA)对妇科手术术后镇痛的效果。方法采用相同的护理措施,随机选取363例采用硬膜外自控镇痛的患者作为实验组,180例术后肌注杜冷丁镇痛作为对照组,观察记录48 h的疼痛及恶心、呕吐等发生情况。结果2组镇痛效果观察,差异有显著意义(P<0.001),副作用及恶心、呕吐与对照组相比明显减少(P<0.005),肠蠕动比对照组恢复快。结论对于减轻妇科手术后患者疼痛硬膜外自控镇痛是一种有效且副作用小的方法。     

硬膜外自控镇痛对妇科手术后镇痛效果观察及护理

目的 了解硬膜外自控镇痛(PECA)对妇科手术术后镇痛的效果.方法 采用相同的护理措施,随机选取363例采用硬膜外自控镇痛的患者作为实验组,180例术后肌注杜冷丁镇痛作为对照组,观察记录48 h的疼痛及恶心、呕吐等发生情况.结果 2组镇痛效果观察,差异有显著意义(P＜0.001),副作用及恶心、呕吐与对照组相比明显减少(P＜0.005),肠蠕动比对照组恢复快.结论 对于减轻妇科手术后患者疼痛硬膜外自控镇痛是一种有效且副作用小的方法.     

比较鞘内和硬膜外吗啡预镇痛对硬膜外自控镇痛患者效果的影响

目的为探寻术后镇痛最佳方案,观察并比较鞘内和硬膜外吗啡预镇痛对术后病人自控镇痛效果的影响。方法选择美国麻醉医师协会分级标准(ASA)I～II级择期在腰麻-硬膜外联合阻滞麻醉下行剖宫产的产妇40例。随机数字法分为鞘内吗啡预镇痛组和硬膜外吗啡预镇痛组,每组20例。腰麻用药均为5g/L布比卡因7.5mg。鞘内吗啡预镇痛组于腰麻药中加0.2mg吗啡,硬膜外吗啡预镇痛组则于硬膜外腔注入2mg吗啡。术后接病人自控镇痛(patientcontrolledanalgesia,PCA)泵行病人硬膜外自控镇痛。记录胎儿取出后1min及5min时的Apgar新生儿评分。观察并记录术后6,12,24,48h的视觉模拟疼痛评分(VAS)、Ramesay镇静评分、PCA总需要量、总体满意度及并发症情况。结果鞘内吗啡预镇痛组术后12,24h的VAS评分显著低于硬膜外吗啡预镇痛组(t=2.578,t=3.584,P<0.05);Ramesay镇静评分显著高于硬膜外吗啡预镇痛组(t=2.629,t=6.201,P<0.05)。鞘内吗啡预镇痛组术后总体满意度显著高于硬膜外吗啡预镇痛组(χ2=4.800,P<0.05),且鞘内吗啡预镇痛组的PCA总需要量明显少于硬膜外吗啡预镇痛组(t=11.260,P<0.01)。两组均无呼吸抑制发生,恶心、呕吐及皮肤瘙痒的发生率差异无显著性意义(χ2=0.114～0.440,P>0.05)。结论在采用术后镇痛时,鞘内吗啡预镇痛效果优于     

椎管内阻滞分娩镇痛后产时发热的影响因素

分娩疼痛容易引起产妇的焦虑、恐惧、紧张等负面情绪,从而对产妇及胎儿产生诸多不良影响。分娩镇痛可以降低产妇的疼痛程度,从而减轻其负面影响。而椎管内阻滞分娩镇痛具有镇痛效果突出、不影响产程、对新生儿影响较小等优点,已成为分娩镇痛的主要手段。但仍有很多人认为分娩镇痛会对胎儿产生不良影响,而拒绝使用。其中就包括产时发热,产时发热对孕妇及新生儿的影响也不容忽视。分娩镇痛与产妇体温升高二者之间关系复杂,本文就椎管内阻滞分娩镇痛产时发热的影响因素进行讨论。     

布托啡诺与吗啡用于患者自控硬膜外术后镇痛的比较

目的:比较布托啡诺与吗啡在硬膜外术后镇痛的效果及不良反应。方法:选取80例择期硬膜外麻醉下行下肢手术患者,分成2组,分别予布托啡诺复合布比卡因(B组)和吗啡复合布比卡因(M组)硬膜外术后镇痛,记录术后4、8、24h视觉模拟评分(VAS评分)、呕吐、尿潴留及瘙痒发生率以及满意率。结果:2组患者术后的镇痛效果均满意,VAS评分<3分。呕吐发生率B组为7.5%,M组为22.5%,B组发生率较M组低。尿潴留发生率B组为7.5%,M组为55.0%,B组要低于M组。满意率B组为90.0%,M组为72.5%,B组的满意率要高。结论:布托啡诺复合布比卡因较吗啡复合布比卡因更适合于作为硬膜外术后镇痛配方。     

病人自控硬膜外镇痛与静脉镇痛用于全髋置换术的比较

目的比较老年病人全髋置换术术后自控硬膜外镇痛（PCEA）与自控静脉镇痛（PCIA）的效果和不良反应。方法选择48例美国麻醉学会分级（ASA）I-Ⅲ级,择期硬膜外麻醉下行全髋置换术的老年病人,术后分别行PCEA（E组）和PCIA（I组）。PCEA药物用1.25mg／ml的罗哌卡因,镇痛泵参数设置为基础量3ml／h、自控给药量（PCA量）5ml、锁定时间30min。PCIA药物用10μg／ml的芬太尼,泵参数为基础量2ml／h、PCA量3ml、锁定时间15min。观察术后48h的镇痛效果和不良反应情况。结果两组术后视觉模拟评分法（VAS）均低于3,术毕初始12h内PCEA提供更低的VAS（P〈0.05）,24-48h两组VAS差异无显著性。术后PCEA病人的低血压、下肢麻木及硬膜外导管脱落的发生率显著高于I组（P〈0.05）。恶心、呕吐、谵妄、皮肤瘙瘁等发生率两组相似。结论老年病人全髋置换术术后病人自控硬膜外镇痛的效果优于自控静脉镇痛,但镇痛管理较为困难。     

Combined analgesia in early periods after cardiosurgical operations

The analgesic efficacy of a combination of two analgesic agents (zaldiar and xefocam) was evaluated in 40 patients in the early period after cardiosurgical operations. In Group 1 including 20 patients, analgesia was made with xefocam, 8 mg, every 12 hours. Group 2 received xefocam, 8 mg, twice daily and zaldiar as 2 tablets every 6 hours within the first 24 hours, then as 1 tablet every 6 hours. The intensity of pain was rated according to the verbal scale. Stimulating spirometry was applied to all the patients after extubation. A volumetric spirometer was used to measure the maximum inspiratory lung capacity. The administration of zaldiar and xefocam provides an effective analgesia that permits avoidance or a considerable reduction in the use of potent opioids in the early period after cardiosurgical operations. Stimulating spirometry may be used to evaluate the efficiency of analgesia when patients begin breathing spontaneously after cardiosurgical operations.     

硬膜外自控镇痛用于开胸手术后镇痛效果的临床观察

目的观察硬膜外自控镇痛用于开胸手术后患者镇痛的临床效果。方法 40例开胸手术患者,随机分为A、B两组(n=20),A组患者开胸术后不用自控镇痛泵,采用肌内注射哌替啶2 mg/kg镇痛;B组患者在麻醉诱导前于T4~5间隙行硬膜外穿刺置管,注射0.25%罗哌卡因5 ml后自控镇痛(PCEA),配方为0.25%罗哌卡因200 ml+昂丹司琼24 mg,并观察记录术后镇痛镇静评分及不良反应。结果 A组镇痛满意度(5.2±1.3)分,B组镇痛满意度(2.0±0.4)分,两组镇痛效果相比较差异有统计学意义(P<0.05)。结论硬膜外自控镇痛是开胸手术患者较理想的镇痛方法。     

Postoperative epidural analgesia

Epidural analgesia is an important advance in the treatment of postoperative pain. Improved pain relief and decreased patient morbidity have combined to make this technique more desirable than the use of traditional intramuscular narcotics. Optimal patient care and satisfaction, however, can only be achieved with the education and assistance of experienced nursing staff familiar with postoperative epidural analgesia therapy.     

股神经和硬膜外自控镇痛在全膝关节置换后的作用

背景：全膝关节置换后疼痛是阻碍早期锻炼的主要问题,置换后镇痛有多种方法可供选择,每种镇痛方法均有自身的优缺点,越来越多的学者趋向于神经阻滞和自控镇痛。目的：比较经股神经自控镇痛和硬膜外自控镇痛在单侧全膝关节置换后镇痛及促进功能恢复效果的差异。方法：选择ASAⅠ～Ⅲ级单侧膝关节置换患者42例,随机分为股神经自控镇痛组和硬膜外自控镇痛组,每组21例,均在连续硬膜外麻醉下实施置换,置换后连接镇痛泵。置换后4,8,12,24和48h,采用目测类比法进行疼痛评分,采用Bromage评分法进行运动阻滞评分;分别记录患者在置换后1,2,3d、1周、1个月患膝关节主动活动的关节活动度以及不良反应发生情况等。结果与结论：全膝关节置换后两组目测类比评分差异无显著性意义,运动阻滞Bromage评分股神经自控镇痛组低于硬膜外自控镇痛组,而且股神经自控镇痛组不良反应明显低于硬膜外自控镇痛组,早期关节活动度也好于硬膜外自控镇痛组。提示股神经自控镇痛在全膝关节置换后的镇痛效果是安全有效的,有利于置换后功能恢复。