Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery.
Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery.
复制标题
上腹部手术后持续硬膜外输注罗哌卡因的术后镇痛。
DOI：
10.1093/bja/76.4.487
复制
发表时间：
1996
影响因子：
9.8
通讯作者：
B. Hägglöf
中科院分区：
文献类型：
--
作者：
S. Schug;D. Scott;J. Payne;P. Mooney;B. Hägglöf
罗哌卡因是一种新型的局部麻醉剂，在术后镇痛中具有重要的作用。本研究的主要目的是探讨硬膜外输注罗哌卡因的量效关系。在一项随机双盲研究中，我们研究了36例ASA I-III级患者在全身麻醉和硬膜外阻滞（T6-9时置管）期间接受上腹部手术，使用0.5%罗哌卡因。术后9例患者均接受硬膜外输注罗哌卡因0.1%、0.2%、0.3%或生理盐水，剂量为10ml h-1，持续21小时。所有患者均通过PCA装置静脉注射吗啡。罗哌卡因组在21 h输注期间吗啡消耗量显著低于生理盐水组（中位数：生理盐水75 mg， 0.1%罗哌卡因32 mg， 0.2%罗哌卡因39 mg， 0.3%罗哌卡因13 mg） （P < 0.05）。注射4 h后，各罗哌卡因组静息疼痛（VAS评分）均显著低于生理盐水组（中位数：生理盐水45 mm； 0.1%罗哌卡因15 mm； 0.2%罗哌卡因12 mm； 0.3%罗哌卡因0 mm）。注射4 h后，所有罗哌卡因组咳嗽疼痛均明显小于生理盐水组（中位数：生理盐水67 mm； 0.1%罗哌卡因44 mm； 0.2%罗哌卡因33 mm； 0.3%罗哌卡因0 mm），稍后0.2%和0.3%罗哌卡因组咳嗽疼痛明显小于生理盐水组。在整个输注过程中，运动阻滞可忽略不计。0.2%和0.3%罗哌卡因组患者满意度高于其他两组。
Ropivacaine is a new local anaesthetic with advantages that suggest an important role in the provision of postoperative analgesia. The main aim of this study was to investigate the dose-response relationship of extradural infusion of ropivacaine. We studied 36 ASA I-III patients undergoing upper abdominal surgery during general anaesthesia and extradural block (catheter insertion at T6-9) using 0.5% ropivacaine in a randomized, double-blind study. After surgery nine patients each received an extradural infusion of either ropivacaine 0.1%, 0.2%, 0.3% or saline at a rate of 10 ml h-1 for 21 h. All patients had access to i.v. morphine via a PCA device. The ropivacaine groups consumed significantly less morphine over the 21-h infusion period than the saline group (medians: saline 75 mg; 0.1% ropivacaine 32 mg; 0.2% ropivacaine 39 mg; 0.3% ropivacaine 13 mg) (P < 0.05). Pain (VAS scores) at rest was significantly lower in all ropivacaine groups than in the saline group after 4 h of infusion (medians: saline 45 mm; 0.1% ropivacaine 15 mm; 0.2% ropivacaine 12 mm; 0.3% ropivacaine 0 mm). Pain on coughing was significantly less in all ropivacaine groups than in the saline group after 4 h infusion (medians: saline 67 mm; 0.1% ropivacaine 44 mm; 0.2% ropivacaine 33 mm; 0.3% ropivacaine 0 mm) and for 0.2% and 0.3% ropivacaine at later times. Motor block was negligible throughout the infusion. Patient satisfaction was higher in the 0.2% and 0.3% ropivacaine groups than in the two other groups.