Sawada N, Higashi K, Yanagi F, Mitsuhata H, Akasaka T, Nishi M
Department of Anesthesiology, Kumamoto University School of Medicine.
Masui. 1999 Mar;48(3):244-50.
We evaluated effects of continuous epidural infusion on postoperative pain, and frequency of its side effects. Patients who had undergone elective gynecological operations were randomly allocated into three groups by difference in duration of indwelling of epidural catheters: patients receiving epidural block only during operations (group M); patients receiving continuous epidural infusion for 2 postoperative days (group B 2); patients receiving continuous epidural infusion for 4 postoperative days (group B 4). In group M, morphine 3 mg and 1 or 2% lidocaine 5-7 ml were given before the start of operation, and epidural catheter was removed after the end of operations. In group B 2 and B 4, morphine 2 mg and 1 or 2% lidocaine 5-7 ml were given before the start of operation, and morphine 8 mg in 50 ml of 0.25% bupivacaine was continuously infused at a rate of 0.5-1 ml.hr-1. We evaluated visual analogue scale (VAS) at rest and moving, and verbal descriptor pain score. Frequencies of supplementary analgesics, vomiting and nausea, residual urine volume after removal of bladder catheter, and timing to initiation of bowel movement after operation were also recorded. VAS at rest was significantly higher in group M than in groups B 2 and B 4 for 2 postoperative days, but no significant difference was seen between the three groups for three postoperative days. VAS at moving did not differ between the 3 groups. Verbal descriptor pain score was significantly higher in group M than in groups B 2 and B 4 for 3 postoperative days, but it was not different between groups B 2 and B 4. In group B 2, patients complained increased abdominal pain after removing catheters. Frequencies of supplementary analgesics were 3.7, 0.6 and 0.4 times in group M, B 2, B 4, respectively. Times to initiation of bowel movement after operation were 39.8, 46.5 and 61.7 hrs in group M, B 2, and B 4, respectively, and most patients in group B 4 felt uncomfortable. These results suggest that continuous epidural analgesia for 2 postoperative days is appropriate, but the duration should be determined according to patient's conditions and complications.
我们评估了持续硬膜外输注对术后疼痛及其副作用发生频率的影响。将接受择期妇科手术的患者根据硬膜外导管留置时间的不同随机分为三组：仅在手术期间接受硬膜外阻滞的患者（M组）；术后连续硬膜外输注2天的患者（B2组）；术后连续硬膜外输注4天的患者（B4组）。在M组中，于手术开始前给予吗啡3mg和1%或2%利多卡因5 - 7ml，手术结束后拔除硬膜外导管。在B2组和B4组中，于手术开始前给予吗啡2mg和1%或2%利多卡因5 - 7ml，并以0.5 - 1ml·hr⁻¹的速率持续输注含8mg吗啡的50ml 0.25%布比卡因。我们评估了静息和活动时的视觉模拟评分（VAS）以及言语描述疼痛评分。还记录了辅助镇痛药的使用频率、呕吐和恶心的发生频率、拔除膀胱导管后的残余尿量以及术后开始排便的时间。术后2天，M组静息时的VAS显著高于B2组和B4组，但术后3天三组之间未见显著差异。活动时的VAS在三组之间无差异。术后3天，M组的言语描述疼痛评分显著高于B2组和B4组，但B2组和B4组之间无差异。在B2组中，患者拔除导管后主诉腹痛加重。辅助镇痛药的使用频率在M组、B2组、B4组中分别为3.7倍、0.6倍和0.4倍。术后开始排便的时间在M组、B2组和B4组中分别为39.8小时、46.5小时和61.7小时，B4组的大多数患者感觉不适。这些结果表明，术后连续硬膜外镇痛2天是合适的，但持续时间应根据患者情况和并发症来确定。
