A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 μg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery
A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 μg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery
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DOI：
10.1097/00000539-199904000-00033
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发表时间：
1999-04-01
影响因子：
5.7
通讯作者：
Gustafsson, U
中科院分区：
文献类型：
--
作者：
Scott, DA;Blake, D;Gustafsson, U
我们在这项前瞻性、随机、双盲研究中的目的是比较单独使用罗哌卡因 2 mg/mL（R 组；n = 60）和联合芬太尼 1 μg/mL（R1F；n = 59）、2 μg/mL（R2F；n = 62）和 4 μg/mL（R4F；n = 62）和 4 μg/mL（R4F；n = 62）硬膜外输注的镇痛效果和副作用。 63) 腹部重大手术后长达 72 小时。术前建立有效的硬膜外神经阻滞；术后，输注速度滴定至最大 14 mL/h 以进行镇痛。输注期间除对乙酰氨基酚外不允许使用其他镇痛药。咳嗽时个体视觉模拟量表评分的中位数为 90% 的患者 24 小时后没有检测到运动阻滞。芬太尼剂量较大时，低血压、恶心和瘙痒更为常见。我们的结论是，在腹部大手术后，硬膜外输注罗哌卡因 2 mg/mL 与芬太尼 4 μg/mL 在 3 天的时间内比单独罗哌卡因或罗哌卡因与较低浓度芬太尼相比，可提供更有效的止痛效果。意义：术后硬膜外镇痛输注被广泛使用，但有关局部麻醉阿片类药物最佳强度的信息很少。在这项双盲前瞻性研究中，我们比较了四种不同硬膜外输注溶液在临床上有用的术后期间的疗效和副作用，并得出结论，硬膜外输注罗哌卡因 2 mg/mL 和芬太尼 4 μg/mL 是最有效的。
Our aim in this prospective, randomized, double-blinded study was to compare the analgesic effectiveness and side effects of epidural infusions with ropivacaine 2 mg/mL alone (Group R; n = 60) and in combination with fentanyl 1 mu g/mL (R1F; n = 59), 2 mu g/mL (R2F; n = 62), and 4 mu g/mL (R4F; n = 63) for up to 72 h after major abdominal surgery. Effective epidural neural blockade was established before surgery; postoperatively, the infusion rate was titrated to a maximum of 14 mL/h for analgesia. No additional analgesics other than acetaminophen were permitted during the infusion. The median of individual visual analog scale score with coughing were 90% of patients had no detectable motor block after 24 h. Hypotension, nausea, and pruritus were more common with the larger dose of fentanyl. We conclude that, after major abdominal surgery, an epidural infusion of ropivacaine 2 mg/mL with fentanyl 4 mu g/mL provided significantly more effective pain relief over a 3-day period than ropivacaine alone or ropivacaine with lower concentrations of fentanyl. Implications: Postoperative epidural analgesic infusions are widely used, but there is little information regarding optimal strengths of opioid with local anesthetic. In this blinded, prospective study, we compared four different epidural infusion solutions for efficacy and side effects over a clinically useful postoperative period and conclude that an epidural infusion of ropivacaine 2 mg/mL with fentanyl 4 mu g/mL was most effective.