不同硬膜外给药方式对全子宫切除患者术后镇痛效果的比较

目的　比较不同硬膜外给药方式对子宫切除手术患者术后镇痛效果的影响。方法　对75例择期子宫全切手术的患者 ,随机单盲分为 3组 ,每组 2 5例 ;Ⅰ组为空白对照组 ,切皮前 10min于硬膜外中加用生理盐水 10ml。Ⅱ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml)至手术结束 (速度 9ml/h)。Ⅲ组切皮前 10min于硬膜外中加用 2 %利多卡因 10ml(其中每ml含芬太尼 2 5 μg ,氟哌啶 0 15mg) ,后于硬膜外中持续泵入罗哌卡因和芬太尼的混合液 (罗哌卡因 0 12 5 % ,芬太尼 2 μg/ml) ,至手术结束 (速度 9ml/h)。所有患者均于气管插管全麻下手术。 3组患者均于手术结束后自控硬膜外镇痛 (PCEA) ,微电脑泵为BaxterAP Ⅱ。自控镇痛液为罗哌卡因和芬太尼的混合液 (罗哌卡因浓度 0 12 5 % ,芬太尼 2 μg/ml) ,预充 5ml,背景剂量 3ml/h ,单次自控镇痛 (PCA)剂量 2ml/次 ,锁定时间 10min ,限量 16ml/h ,术后镇痛维持 4 8h。结果　第 1个 2 4h自控镇痛的视觉模拟(VAS)评分静息时Ⅰ组为 2 2分± 1 5分 ,Ⅱ组为 1 4分± 0 78分 ,Ⅲ组为 1 1分± 1 1分 ;Ⅰ组与Ⅱ组比较P <0 0 5 ,I组与Ⅲ组比较P <0 0 1

Effects of preincisional epidural administration of lidocaine and fentanyl on postoperative pain management following hysterectomy

OBJECTIVE: To compare the effect of preincisional administration different combination of epidural lidocaine and fentanyl on postoperative analgesia after hysterectomy. METHODS: 75 ASA I-II patients undergoing hysterectomy who were matched in age, weight, and duration of surgical procedure, were randomly allocated to one of the three treatment groups, 25 in each: group I receiving epidural saline as control, group II receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl 30 minutes before skin incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery, and group III receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl and 0.15 mg/ml of droperidol 30 min before incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery. Patient-controlled epidural analgesia (0.125% ropivacaine and 2 microg/ml fentanyl.) was given for postoperative pain relief in all groups (5 ml bolus followed by 3 ml/h infusion, PCA dose: 2 ml, lock out time: 10 min.). Postoperative pain intensity at rest and during movement was assessed on a visual analogue scale (VAS) by a blinded observer for 48 h after surgery. Analgesic requirements and side effects were compared among the three groups. RESULTS: In the first 24 hours after surgery, the VAS score at rest reported by the patients in group I was 2.2 +/- 1.5, significantly higher than that in group II (1.4 +/- 0.8, P < 0.05,) and that in group III (1.1 +/- 1.1, P < 0.01), while the VAS score during coughing in group I was 3.0 +/- 1.1, higher than that in group II (2.1 +/- 0.8) and that in group III (1.5 + 1.3,P < 0.01 ). Analgesic requirements in the first 24 hours were 101 +/- 17 ml in group I, 82 +/-9 ml in group II, and 78 ml +/- 9 ml in group III, without significant difference among the groups. However, the analgesic requirement in the second 24 hours was 82 +/- 11 ml in group I, much more than that in group II (76 +/- 5 ml, P < 0.05) and in group III (73 ml +/- 2 ml, P < 0.01). The incidence of nausea, was significantly higher in Group I than in group III (P < 0.05). The incidence rates of pruritus and motor block were higher in group I too. CONCLUSION: The preoperative administration of epidural lidocaine and small dose of fentanyl with droperidol, compared with saline administration, improves the postoperative pain management and reduces postoperative analgesic consumption and side effects.