Brodner G, Mertes N, Van Aken H, Möllhoff T, Zahl M, Wirtz S, Marcus M A, Buerkle H
Department of Anesthesiology and Surgical Intensive Care, University of Münster, Münster, Germany.
Anesth Analg. 2000 Mar;90(3):649-57. doi: 10.1097/00000539-200003000-00027.
In this randomized double-blinded study, we sought to determine an optimal dose-combination of sufentanil with ropivacaine 0.2% wt/vol as postoperative epidural analgesics. One hundred twenty patients undergoing major abdominal surgery under general and thoracic epidural anesthesia (T9-11) were assigned to groups receiving patient-controlled epidural analgesia with ropivacaine 0.2% wt/vol (R), ropivacaine 0.2% wt/vol + sufentanil 0.5 microg/mL (R+S0.5), 0. 75 microg/mL (R+S0.75), 1.0 microg/mL (R+S1). A visual analog score of less than 40 was considered effective, and all side effects were recorded. In randomized subgroups (10 patients per group), plasma pharmacokinetic data were obtained for both epidural drugs. Four patients in Group R and two in Group R+S0.5 were excluded because of inadequate analgesia. The drug infusion rates (range of means: 5.4-5. 9 mL/h) were similar in all patients. Analgesia was superior for sufentanil 0.75 microg/mL with no further enhancement by the larger sufentanil concentration of 1 microg/mL. Sufentanil plasma levels were within the range of the minimal effective concentrations (highest in R+S1), and there was no covariation between plasma levels and pain relief. Free ropivacaine plasma concentrations remained stable for 96 h. No severe side effects were detected, although pruritus correlated with an increasing dose of sufentanil. We conclude that the combination of ropivacaine 0.2% wt/vol and 0.75 microg/mL sufentanil provided the best analgesia with the fewest side effects of the three combinations tested.
Sufentanil is added to epidural infusions of ropivacaine 0.2% wt/vol to improve the effectiveness of postoperative pain management. Regarding the risk of side effects, however, it is still unclear what concentration of sufentanil should be added to the local anesthetic. For postoperative thoracic epidural analgesia after major abdominal surgery, the combination of ropivacaine 0.2% wt/vol and 0.75 microg/mL sufentanil resulted in an appropriate cost:benefit ratio between good analgesia and side effects.
在这项随机双盲研究中，我们试图确定舒芬太尼与0.2%（重量/体积）罗哌卡因作为术后硬膜外镇痛药物的最佳剂量组合。120例接受全身麻醉和胸段硬膜外麻醉（T9 - 11）下腹部大手术的患者被分为接受0.2%（重量/体积）罗哌卡因（R组）、0.2%（重量/体积）罗哌卡因 + 0.5微克/毫升舒芬太尼（R + S0.5组）、0.75微克/毫升舒芬太尼（R + S0.75组）、1.0微克/毫升舒芬太尼（R + S1组）进行患者自控硬膜外镇痛的组。视觉模拟评分小于40被认为有效，并记录所有副作用。在随机亚组（每组10例患者）中，获取两种硬膜外药物的血浆药代动力学数据。R组4例患者和R + S0.5组2例患者因镇痛不足被排除。所有患者的药物输注速率（均值范围：5.4 - 5.9毫升/小时）相似。0.75微克/毫升舒芬太尼的镇痛效果更佳，1微克/毫升更高浓度的舒芬太尼并未进一步增强镇痛效果。舒芬太尼血浆水平在最低有效浓度范围内（R + S1组最高），且血浆水平与疼痛缓解之间无协变关系。游离罗哌卡因血浆浓度在96小时内保持稳定。未检测到严重副作用，尽管瘙痒与舒芬太尼剂量增加相关。我们得出结论，0.2%（重量/体积）罗哌卡因与0.75微克/毫升舒芬太尼的组合在所测试的三种组合中提供了最佳镇痛效果且副作用最少。
在0.2%（重量/体积）罗哌卡因硬膜外输注中添加舒芬太尼可提高术后疼痛管理的有效性。然而，关于副作用风险，仍不清楚应向局部麻醉药中添加何种浓度的舒芬太尼。对于腹部大手术后的术后胸段硬膜外镇痛，0.2%（重量/体积）罗哌卡因与0.75微克/毫升舒芬太尼的组合在良好镇痛与副作用之间产生了合适的成本效益比。
