不同浓度罗哌卡因复合布托啡诺患者自控硬膜外镇痛的临床比较

目的比较3种不同浓度罗哌卡因复合布托啡诺患者自控硬膜外镇痛（PCEA）的镇痛效果、胃肠动力、运动阻滞的影响,探讨罗哌卡因复合布托啡诺PCEA的最佳浓度。方法90例择期硬膜外麻醉行妇科手术的患者,术后PCEA随机接受0.075%、0.1%和0.125%罗哌卡因复合布托啡诺6mg、氟哌利多2.5mg,自控镇痛的设置为：总量120ml,初始负荷剂量5ml,背景剂量恒速2ml/h,自控2ml/次,间隔时间15min。镇痛效果、胃肠动力及下肢肌力的评估指标分别为：视觉模拟量表（VAS）、第1次肛门排气或者排便时间和修正Bromage分级。采集数据时间：手术当天17：00、术后第1天08：00、术后第1天17：00、术后第2天8：00。结果3组的镇痛效果、胃肠动力及运动阻滞比较无统计学意义。三组均能提供较好的镇痛效果,且无下肢运动的阻滞。结论0.075%罗哌卡因PCEA可以提供较好的镇痛效果,保护胃肠动力,无运动阻滞。

A comparison of three different concentrations of ropivacaine with butorphanol for Patient-Controlled epidural analgesia

Objective to compare the analgesia,bowel function and motor function in three different concentrations of ropivacaine with butorphanol for patient-controlled epidural analgesia（PECA）,discuss the optimal concentration of ropivacaine in combination with butorphanol for PECA. Methods Ninety women scheduled to undergo gynecologic lower abdominal surgery,were randomly allocated to receive ropivacaine 0.075%,0.1%,0.125% in combination with butorphanol 6 mg and droperidol 2.5 mg. The settings of patient-controlled epidural analgesia were as follows：total volume 120 ml,initial loading volume 5 ml,background infusion 2 ml/h,bolus volume 2 ml,and lockout interval 15 minutes. Pain was assessed with a visual analog scale.Bowel function was evaluated by the first passage of flatus,and motor function was examined by modified Bromage scale. Data were collected in the evening on the day of surgery,in the morning and in the evening on the first postoperative day,and in the morning on the second postoperative day. Results Analgesia,Gastrointestinal motility and motor blockade was not different among the three groups. All three solutions produced equivalent analgesia and no motor blockade. Conclusion We conclude that ropivacaine 0.075% is sufficient to preserve gastrointestinal motility,and provides excellent postoperative pain relief without motor blockade.