A Prospective, Randomized, Double-Blind Comparison of Epidural and Intravenous Sufentanil After Radical Retropubic Prostatectomy
A Prospective, Randomized, Double-Blind Comparison of Epidural and Intravenous Sufentanil After Radical Retropubic Prostatectomy
复制标题
根治性耻骨后前列腺切除术后硬膜外注射和静脉注射舒芬太尼的前瞻性、随机、双盲比较
DOI：
10.1136/rapm-00115550-199621021-00014
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发表时间：
1996
影响因子：
5.1
通讯作者：
N. Sakima
中科院分区：
文献类型：
--
作者：
J. Grass;N. Sakima
简介脂溶性阿片类药物硬膜外给药的作用部位（脊髓与中枢）和临床益处一直是一个有争议的话题。我们比较了根治性耻骨下前列腺切除术 (RRP) 后硬膜外 (Son) 和静脉 (Sw) 注射舒芬太尼的镇痛效果、血浆浓度、副作用以及对恢复速度和应激儿茶酚胺和皮质醇反应的影响。方法经过 1RB 批准和书面知情同意书后，16 例腰硬膜外麻醉下接受 RRP 的患者随机接受 SEPI 或 Sjv（n= 8/组）采用双激活、双盲 PCA 泵装置。在首次抱怨术后疼痛时，Sw 患者接受 8 毫克推注，然后静脉输注 6 无花果/小时。 SEW 患者接受相同的硬膜外推注和输注。所有患者均接受推注并通过替代途径输注编码盐水。通过指定的给药途径由患者控制补充推注 4 g（10 分钟锁定），或按预定时间间隔减少 2 ng/h 的输注速度，根据个人需要不断调整镇痛要求。在初次推注后72小时内评估患者休息时和起床时的疼痛（0-100毫米视觉模拟量表，VAS）、镇静、恶心、呕吐、瘙痒、满意度、舒芬太尼的使用和血浆水平、血浆肾上腺素和去甲肾上腺素水平以及尿皮质醇排泄。记录恢复参数。结果两组之间发现相似的VAS疼痛评分：静息时疼痛<，30毫米由30名修女建立并始终维持； POD1 时 OOB 时的疼痛为 45 毫米，POD3 时降至 26 毫米。镇静、恶心、呕吐、瘙痒、满意度、恢复参数、舒芬太尼使用或血浆水平没有差异。 24 小时时的平均舒芬太尼需求量 (±SD)：289±75 Jig (Siv)、292±72 Fig (SEPI)； 48 小时：499±174 ng (Snr)、504±129 Hg (SEPI)； 72小时：687±261无花果（Sw）、669±270无花果（SEPI）-与术前基线相比，两组在疼痛主诉时和15分钟后均轻微升高（P<0.05），但随后均恢复至基线范围。两组之间的尿液皮质醇排泄相似。讨论本研究证实了之前的两项研究，发现舒芬太尼硬膜外给药和静脉给药之间几乎没有临床差异(1, 2)。此外，硬膜外麻醉下 RRP 后的应激反应很轻微，硬膜外或静脉注射舒芬太尼同样可以抑制应激反应。
IntroductionThe site of action (spinal vs. central) and clinical benefits of epidural administration of lipid-soluble opioids has been a subject of controversy. We compared the analgesic efficacy, plasma concentration, side effects, and impact on speed of recovery and stress catecholamine and cortisol responses of epidural (Son) and intravenously (Sw) administered sufentanil after radical rctropubic prostatectomy (RRP).MethodsAfter 1RB approval and written informed consent, 16 patients undergoing RRP under lumbar epidural anesthesia were randomized to receive SEPI or Sjv (n= 8/group) utilizing a dual activated, double-blind PCA pump set-up. On first complaint of postoperative pain, Sw patients were given an 8 jig bolus and then a 6 fig/h infusion intravenously. SEW patients were given the same bolus and infusion epidurally. All patients received bolus injections and an infusion of coded saline via the alternate route. Analgesic requirements were tailored continuously to individual needs by patientcontrolled supplementary boluses of 4 g (10 min lockout) via the designated route of delivery, or by 2 ng/h reduction in infusion rate at predetermined intervals. Patients were assessed for pain (0-100 mm visual analogue scale, VAS) at rest and with getting out of bed (OOB), sedation, nausea, vomiting, pruritus, satisfaction, sufentanil use and plasma levels, plasma epinephrine and norepinephrine levels, and urine cortisol excretion for 72 h after the initial bolus. Recovery parameters were recorded.ResultsSimilar VAS pain scores were found between the two groups: pain at rest<, 30 mm was established by 30 nun and maintained throughout; pain with getting OOB was£ 45 mm on POD1 and decreased to<> 26 mm on POD3. There were no differences in sedation, nausea, vomiting, pruritus, satisfaction, recovery parameters, sufentanil use or plasma levels. Mean sufentanil requirements (±SD) were at 24h: 289±75 Jig (Siv), 292±72 fig (SEPI); at 48h: 499±174 ng (Snr), 504±129 Hg (SEPI); and at 72h: 687±261 fig (Sw), 669±270 fig (SEPI)-Epinephrine and norepinephrine levels were mildly elevated equally in both groups at complaint of pain and 15 min later compared to preoperative baselines (P< 0.05), but returned to baseline ranges in both groups thereafter. Urine cortisol excretion was similar between the two groups.DiscussionThis study corroborates two previous studies which found that little clinical difference exists between epidural and intravenous administration of sufentanil (1, 2). Furthermore, the stress response after RRP under epidural anesthesia is mild and equally suppressed by either epidural or intravenous administration of sufentanil.