Kang F C, Tsai Y C, Chang P J, Chen T Y
Department of Anesthesiology, National Cheng Kung University, College of Medicine, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1998 Dec;36(4):207-14.
The use of neuraxial opioid was very popular in recent years, and they may augment the analgesia produced by local anesthetic through direct binding with the spinal opioid receptors. Hemodynamic stability is very important during Cesarean section. Theoretically, the reduction of local anesthetic by addition of fentanyl would provide better hemodynamic stability and good anesthetic status.
Thirty healthy parturients undergoing Cesarean section were assessed in a randomized fashion. They were divided into two groups. Each subject received 5 mg hyperbaric bupivacaine plus 25 micrograms fentanyl (0.5 ml) and cerebrospinal fluid (CSF) 0.6 ml (Group M + F) or 8 mg hyperbaric bupivacaine plus 0.5 ml of CSF (Group M). The effects of hemodynamic stability, side effects, and complete analgesic duration were observed.
It was disclosed that the hemodynamic status was more stable in group M + F. The incidence of nausea and vomiting appeared to be not statistically significant between groups. The incidence of pruritus was apparently higher in group M + F (93.5% vs. 0) but the incidence of shivering was much lower in group M + F (0 vs. 33.3%). The complete analgesic duration was longer in group M + F (146 +/- 47 min vs. 104 +/- 44 min). There were no significant differences in the anesthetic and surgical status, 1-min and 5-min Apgar scores, and the time of regression of sensory level to T10.
The combination of small-dose bupivacaine with fentanyl could provide more stable hemodynamic status, longer postoperative analgesia, and lower incidence of shivering. The incidence of pruritus in group M + F was high, but it was usually mild.
近年来，神经轴索阿片类药物的使用非常普遍，它们可能通过与脊髓阿片受体直接结合来增强局部麻醉药产生的镇痛效果。剖宫产术中血流动力学稳定性非常重要。从理论上讲，添加芬太尼减少局部麻醉药用量可提供更好的血流动力学稳定性和良好的麻醉状态。
对30例行剖宫产术的健康产妇进行随机评估。她们被分为两组。每组受试者接受5mg重比重布比卡因加25μg芬太尼（0.5ml）和0.6ml脑脊液（CSF）（M + F组）或8mg重比重布比卡因加0.5ml脑脊液（M组）。观察血流动力学稳定性、副作用及完全镇痛持续时间的影响。
结果显示，M + F组的血流动力学状态更稳定。两组间恶心呕吐的发生率似乎无统计学意义。M + F组瘙痒发生率明显更高（93.5%对0），但M + F组寒战发生率低得多（0对33.3%）。M + F组的完全镇痛持续时间更长（146±47分钟对104±44分钟）。麻醉和手术状态、1分钟和5分钟阿氏评分以及感觉平面恢复到T10的时间无显著差异。
小剂量布比卡因与芬太尼联合应用可提供更稳定的血流动力学状态、更长的术后镇痛时间以及更低的寒战发生率。M + F组瘙痒发生率高，但通常较轻。
