Kampe S, Weigand C, Kaufmann J, Klimek M, König D P, Lynch J
Department of Anesthesiology, University of Cologne, Germany.
Anesth Analg. 1999 Aug;89(2):395-8. doi: 10.1097/00000539-199908000-00027.
We assessed the analgesic efficacy of postoperative epidural ropivacaine 0.1% with and without sufentanil 1 microgram/mL in this prospective, randomized, single-blinded study of 30 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. After surgery, the epidural infusion was commenced. Fifteen patients in each group received either an epidural infusion of 0.1% ropivacaine with 1 microgram/mL sufentanil (R + S) or 0.1% ropivacaine without sufentanil (R) at a rate of 5-9 mL/h. All patients had access to i.v. piritramide via a patient-controlled analgesia device. The R + S group consumed six times less piritramide over a 48-h infusion period than the R group (median 12.7 vs 73.0 mg; P < 0.001). Motor block was negligible for the study duration in both groups. Patient satisfaction was excellent. The incidence of adverse events, such as nausea, was similar. We conclude that a continuous epidural infusion of 0.1% ropivacaine with 1 microgram/mL sufentanil is more effective than ropivacaine alone in treating pain after elective hip replacement without motor block.
This is the first randomized study comparing the efficacy of the epidural combination of ropivacaine 0.1% and sufentanil 1 microgram/mL versus plain ropivacaine 0.1% in treating pain after hip replacement. We found that ropivacaine 0.1% and sufentanil 1 microgram/mL led to a sixfold reduction in opioid requirements after total hip replacement by producing a negligible motor block.
在这项前瞻性、随机、单盲研究中，我们评估了0.1%罗哌卡因加或不加1微克/毫升舒芬太尼用于30例接受择期全髋关节置换术的ASA身体状况I - III级患者术后硬膜外镇痛的效果。使用0.75%罗哌卡因进行腰段硬膜外阻滞，并联合丙泊酚镇静或全身麻醉进行手术。术后开始硬膜外输注。每组15例患者分别接受以5 - 9毫升/小时的速率硬膜外输注含1微克/毫升舒芬太尼的0.1%罗哌卡因（R + S）或不含舒芬太尼的0.1%罗哌卡因（R）。所有患者均可通过患者自控镇痛装置静脉注射匹米诺定。在48小时的输注期内，R + S组匹米诺定的消耗量比R组少六倍（中位数12.7毫克对73.0毫克；P < 0.001）。两组在研究期间运动阻滞均可忽略不计。患者满意度极佳。恶心等不良事件的发生率相似。我们得出结论，持续硬膜外输注含1微克/毫升舒芬太尼的0.1%罗哌卡因在治疗择期髋关节置换术后疼痛方面比单独使用罗哌卡因更有效，且无运动阻滞。
这是第一项比较0.1%罗哌卡因与1微克/毫升舒芬太尼硬膜外联合用药与单纯0.1%罗哌卡因用于髋关节置换术后镇痛效果的随机研究。我们发现，0.1%罗哌卡因与1微克/毫升舒芬太尼在全髋关节置换术后使阿片类药物需求量减少了六倍，同时产生的运动阻滞可忽略不计。
