盐酸丁卡因粉剂用于开胸手术后硬膜外镇痛

研究盐酸丁卡因粉剂用于开胸肺叶切除术后硬膜外麻醉病人自控镇痛的镇痛效果及其对呼吸和循环功能的影响。43例全麻下开胸肺叶切除术病人，随机分为盐酸丁卡因(22例)和盐酸罗哌卡因(21例)两组。两组病人术后均使用病人自控硬膜外镇痛泵，分别采用0．15％丁卡因与0．3％罗哌卡因行硬膜外镇痛48h。镇痛泵设定为单次注射模式：单次剂量6mL，锁定时间1h。采用视觉模拟评分(VAS)评估镇痛效果。术前及术后每日测定用力肺活量(FVC)，第一秒用力呼气量(FEV1.0)，第一秒用力呼气量占用力肺活量的百分率(FEV1.0/FVC)及呼气流量峰值(PEF)。监测并记录每次注药前后的血流动力学指标。结果表明，硬膜外单次注射局麻药后两组病人VAS均显著降低。两组间术后FEV1.0/FVC和PEF改变率无显著性差异。给药后两组病人心率、血压、血氧饱和度的改变率亦无显著性差异。开胸术后使用0．15％丁卡因行病人自控硬膜外镇痛的镇痛效果及对呼吸和循环功能的影响与0．3％罗哌卡因相似，未见严重不良反应发生。

Epidural analgesia with tetracaine hydrochloride after thoracotomy

To investigate the analgesic effect of powdered tetracaine hydrochloride and it's impact on respiratory and circulatory functions in patient controlled epidural analgesia (PCEA) after pulmonary lobectomy via thoracotomy. Forty three patients scheduled for elective pulmonary lobectomy undergoing general anesthesia were randomly allocated into either tetracaine group (22 patients) or ropivacaine group (21 patients). In the tetracaine group, 0.15% tetracaine hydrochloride was given for epidural postoperative analgesia, while 0.3% ropivacaine hydrochloride was used in the ropivacaine group for 48 h via a patient controlled analgesia pump. The pump was set up for bolus injections of 6 mL with a lockout time of 1 h. Postoperative pain score was recorded by visual analogue scale (VAS). Forced expiratory volume at 1st s (FEV1.0), forced volume capacity (FVC), FEV1.0/ FVC and peak expiratory flow (PEF) were measured preoperatively and then daily after surgery. Hemodynamics were monitored and recorded before and after administration of local anesthetics during the study period. The results showed that VAS in both groups was significantly decreased after bolus injection of local anesthetics. There was no significant difference between the two groups in terms of percentage of postoperative changes of FEV1.0/FVC and PEF. There was no significant difference between the two groups in the percentage of changes of heart rate, mean arterial blood pressure and SaO 2 after administration of local anesthetics. The analgesic effects of 0.15% tetracaine Hydrochloride and its impact on respiratory and circulatory functions were similar to that of 0.3% ropivacaine while administered in patient controlled epidural analgesia mode after thoracotomy. No serious side effects was observed.