Obata H, Saito S, Fujita N, Fuse Y, Ishizaki K, Goto F
Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Maebashi, Japan.
Can J Anaesth. 1999 Dec;46(12):1127-32. doi: 10.1007/BF03015520.
To examine the effect of continuous epidural block initiated before thoracic surgery upon early and long-term postoperative pain.
In a double-blind study, 70 patients scheduled for thoracic surgery under general anesthesia were assigned randomly to receive continuous epidural block with mepivacaine 1.5% initiated either 20 min before surgical incision (Pre group) or at completion of surgery (Post group). In both groups the initial dose was 4 ml, followed by a continuous infusion at 4 ml x hr(-1) until 72 hr after operation. Indomethacin suppositories, 50 mg, were administered on request as supplementary analgesics. Visual analogue scale at rest was assessed four hours after operation, and then every 24 hr after operation on postoperative days 1 through 7, and also days 14 and 30. At three and six months after operation, all patients were interviewed by telephone with respect to postoperative pain. The most severe pain was assessed using modified numerical rating scale.
By a visual analogue scale, postoperative pain was less in the Pre group than in the Post group at four hours, two and three days after operation (P < 0.05). By a numerical rating scale six months after operation, pain was less in the Pre group than in the Post group (P = 0.015). The percentage of pain-free patients was higher in the Pre group than in the Post group at three (P = 0.035) and six (P = 0.0086) months after operation.
Continuous epidural block initiated prior to surgery may reduce long-term post-thoracotomy pain.
探讨胸外科手术前开始的连续硬膜外阻滞对术后早期及长期疼痛的影响。
在一项双盲研究中，70例计划在全身麻醉下行胸外科手术的患者被随机分配，分别于手术切口前20分钟（术前组）或手术结束时（术后组）接受1.5%甲哌卡因连续硬膜外阻滞。两组初始剂量均为4 ml，随后以4 ml/小时的速度持续输注，直至术后72小时。根据需要给予50 mg吲哚美辛栓剂作为辅助镇痛药。术后4小时评估静息状态下的视觉模拟评分，然后在术后第1至7天以及第14天和第30天，每24小时评估一次。在术后3个月和6个月，通过电话采访所有患者关于术后疼痛的情况。使用改良数字评分量表评估最严重的疼痛。
根据视觉模拟评分，术前组术后4小时、术后2天和3天的疼痛程度低于术后组（P < 0.05）。根据数字评分量表，术后6个月，术前组的疼痛程度低于术后组（P = 0.015）。术后3个月（P = 0.035）和6个月（P = 0.0086），术前组无痛患者的百分比高于术后组。
手术前开始的连续硬膜外阻滞可能减轻开胸术后的长期疼痛。
