Silvasti M, Pitkänen M
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Scand. 2000 Jan;44(1):37-42. doi: 10.1034/j.1399-6576.2000.440107.x.
Both epidural analgesia and intravenous patient-controlled analgesia (PCA) have been found efficacious after various types of surgery. We compared the efficacy, safety, side effects and patient satisfaction of these methods in a randomized double-blind fashion after elective anterior cruciate ligament reconstruction of the knee.
Fifty-six patients had an epidural catheter placed at the L2-L3 interspace. Spinal anaesthesia with 15 mg of plain bupivacaine 5 mg/ml was performed at the L3-L4 interspace. After surgery the patients were randomly divided into three groups: 19 received a continuous epidural infusion with bupivacaine 1 mg/ml and fentanyl 10 mg/ml (F10), 19 patients received bupivacaine 1 mg/ml and fentanyl 5 microg/ml (F5) and 18 patients received saline (S). The rate of the epidural infusions was 0.1 ml kg(-1) h(-1). Each patient could also use an intravenous (i.v.) PCA device with 40 microg/kg bolus doses of morphine with a lockout period of 10 min and a maximum dose 240 microg kg(-1) h(-1). At the end of surgery ketoprofen 100 mg i.v. was given and continued orally three times a day. Patients were assessed for pain with a visual analogue scale (VAS) at rest and during activity, side effects and satisfaction at 3, 9 and 20 h.
Both epidural infusions (F10, F5) provided better analgesia than epidural saline plus i.v. PCA (S) (P<0.05). There was slightly less nausea in the S group (NS). In spite of the difference in the quality of pain relief, there was no difference between the groups in patient satisfaction regarding analgesic therapy.
Epidural infusion of fentanyl (1 microg kg(-1) h(-1) or 0.5 microg kg(-1) h(-1)) and bupivacaine (0.1 mg kg(-1) h(-1)) provided better pain relief but more side effects than intravenous morphine patient-controlled analgesia after knee ligament surgery. Almost all patients in all groups were satisfied with their pain relief.
硬膜外镇痛和静脉自控镇痛（PCA）在各类手术后均被证实有效。我们采用随机双盲方式，比较了在择期膝关节前交叉韧带重建术后这两种镇痛方法的疗效、安全性、副作用及患者满意度。
56例患者在L2 - L3间隙置入硬膜外导管。于L3 - L4间隙行15mg 5mg/ml的布比卡因单纯腰麻。术后患者被随机分为三组：19例接受含1mg/ml布比卡因和10μg/ml芬太尼的持续硬膜外输注（F10），19例接受含1mg/ml布比卡因和5μg/ml芬太尼的输注（F5），18例接受生理盐水输注（S）。硬膜外输注速率为0.1ml·kg⁻¹·h⁻¹。每位患者还可使用静脉PCA装置，静脉注射吗啡剂量为40μg/kg，锁定时间为10分钟，最大剂量为240μg·kg⁻¹·h⁻¹。手术结束时静脉注射酮洛芬100mg，并每日口服三次。在术后3、9和20小时，采用视觉模拟评分法（VAS）评估患者静息及活动时的疼痛情况、副作用及满意度。
两种硬膜外输注方式（F10、F5）的镇痛效果均优于硬膜外输注生理盐水加静脉PCA（S）（P<0.05）。S组恶心症状略少（无统计学差异）。尽管在疼痛缓解质量上存在差异，但在镇痛治疗的患者满意度方面，各组之间并无差异。
膝关节韧带手术后，硬膜外输注芬太尼（1μg·kg⁻¹·h⁻¹或0.5μg·kg⁻¹·h⁻¹）和布比卡因（0.1mg·kg⁻¹·h⁻¹）比静脉注射吗啡自控镇痛提供了更好的疼痛缓解，但副作用更多。几乎所有组的患者对其疼痛缓解情况都感到满意。
