A RANDOMIZED DOUBLE-BLIND COMPARISON OF EPIDURAL VERSUS INTRAVENOUS FENTANYL INFUSION FOR ANALGESIA AFTER CESAREAN-SECTION
A RANDOMIZED DOUBLE-BLIND COMPARISON OF EPIDURAL VERSUS INTRAVENOUS FENTANYL INFUSION FOR ANALGESIA AFTER CESAREAN-SECTION
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DOI：
10.1097/00000542-199006000-00006
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发表时间：
1990-06-01
期刊：
影响因子：
8.8
通讯作者：
REISNER, LS
中科院分区：
文献类型：
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作者：
ELLIS, DJ;MILLAR, WL;REISNER, LS
作者进行了一项随机双盲对照研究，对接受静脉或硬膜外芬太尼输注的患者进行比较，以确定在类似的止痛水平下，1)副作用的严重程度不同；2)两组之间的芬太尼血浆浓度不同。选择28例ASA择期剖宫产患者，随机分为两组：芬太尼静脉注射加生理盐水硬膜外注射或芬太尼硬膜外注射加生理盐水注射。在硬膜外麻醉下分娩婴儿后，每个患者静脉或硬膜外注射芬太尼1.5微克/公斤，并通过相同的途径开始芬太尼输注。同时，通过另一种途径进行生理盐水推注和输液。调整芬太尼和生理盐水的输注率，直到每个患者都感到舒适。患者对他们的计划、恶心和瘙痒进行视觉模拟评分。镇静由观察者进行评估。呼吸抑制通过呼气末二氧化碳分压进行评估。数据分析采用非配对双尾t检验。分别在12小时和24小时测定芬太尼的血药浓度。静注组中有3名患者因疼痛缓解不充分而退出研究。其余25例患者在12小时和24小时需要相似的芬太尼输注速度以产生相似水平的止痛。两组恶心、瘙痒和镇静的严重程度以及呼气末二氧化碳分压(PCO2)相似。静脉注射芬太尼后12h的芬太尼血药浓度明显高于静脉注射芬太尼的患者，但在24 h时无明显变化，提示硬膜外输注芬太尼用于剖宫产术后镇痛并无临床优势。
The authors conducted a randomized double-blind controlled study comparing groups of patients receiving iv or epidural fentanyl infusions to determine whether, at comparable levels of analgesia, 1) the severity of side effects was different; and 2) plasma fentanyl concentrations differed between the two groups. Twenty-eight ASA physical status 2 women scheduled to undergo elective cesarean section were randomized into two groups to either receive fentanyl intravenously and saline epidurally or fentanyl epidurally and saline intravenously. After delivery of the infants under epidural anesthesia, each patient received a bolus of fentanyl 1.5 .mu.g/kg either intravenously or epidurally, and a fentanyl infusion was begun via the same route. Concurrently, a saline bolus and infusion were given via the alternate route. The rates of the fentanyl and saline infusions were adjusted until each patient was comfortable. Patients rated their plan, nausea, and pruritus on visual analogue scales. Sedation was evaluated by an observer. Respiratory depression was evaluated by end-tidal PCO2. Data were analyzed by unpaired two-tail t tests. Plasma fentanyl concentrations were measured at 12 and 24 h. Three patients in the iv group were dropped from the study because of inadequate pain relief. For the remaining 25 patients, similar infusion rates of fentanyl were required to produce similar levels of analgesia at 12 and 24 h. The severity of nausea, pruritus and sedation, and end-tidal PCO2 were similar for both groups. The plasma concentrations of fentanyl were significantly greater in those who received iv fentanyl at 12 h but not at 24 h. In conclusion, there appears to be no clinical advantage to epidural infusion over iv infusion of fentanyl for analgesia after cesarean section.