Hernández-Palazón J, Tortosa Serrano J A, Martínez-Pérez M, Piqueras-Pérez C, Burguillos López S
Servicios de Anestesiología y Reanimación y Neurocirugía, Hospital Universitario Virgen de la Arrixaca, Murcia.
Rev Esp Anestesiol Reanim. 2001 Feb;48(2):59-64.
To determine the optimum concentration of bupivacaine administered by continuous epidural infusion, using a Baxter Single Day elastomeric infusor at a rate of 2 ml/h, to treat pain during the first 24 h after lumbar laminectomy.
Sixty patients undergoing elective repair of a herniated lumbar disk were randomly assigned to three homogeneous groups of 20 each. Group I received epidural infusion of 0.0625% bupivacaine, group II received 0.125% bupivacaine and group III received 0.25% bupivacaine. After surgery each patient was given a 4 mL solution of the local anesthetic being studied, followed by an infusion of the same through an elastomeric infusor at a rate of 2 ml/h throughout the first 24 h after surgery. Ketorolac was delivered through a device for patient controlled analgesia after surgery. Pain was assessed on a visual analog scale (VAS) at rest and during movement. Pain relief was assessed on a simple descriptive scale.
Significantly less ketorolac was required during epidural infusion of 0.125% and 0.25% bupivacaine than when the 0.0625% concentration was being infused (29 +/- 16 and 28 +/- 13 mg, respectively, versus 110 +/- 35 mg; p < 0.001). VAS scores were significantly lower during infusion of 0.125% and 0.25% bupivacaine than with 0.0625% bupivacaine. No instances of motor blockade or infection related to catheter insertion were observed in any of the patients.
Continuous epidural infusion of 0.125% and 0.25% bupivacaine through an elastomeric infusor gives excellent analgesia during the first 24 h after surgery. Administration of 0.25% bupivacaine is associated with a higher incidence of urinary retention. We therefore think that the most recommendable concentration of bupivacaine for infusion is 0.125%.
使用百特单日弹性输液器以2毫升/小时的速率持续硬膜外输注布比卡因，确定其最佳浓度，用于治疗腰椎椎板切除术后最初24小时内的疼痛。
60例行择期腰椎间盘突出症修复术的患者被随机分为三组，每组20例。第一组接受0.0625%布比卡因硬膜外输注，第二组接受0.125%布比卡因硬膜外输注，第三组接受0.25%布比卡因硬膜外输注。术后，每位患者均给予4毫升正在研究的局部麻醉剂溶液，随后在术后的最初24小时内通过弹性输液器以2毫升/小时的速率输注相同的局部麻醉剂。酮咯酸通过术后患者自控镇痛装置给药。在静息和活动时，采用视觉模拟评分法（VAS）评估疼痛程度。采用简单描述性量表评估疼痛缓解情况。
与输注0.0625%浓度的布比卡因相比，输注0.125%和0.25%布比卡因时所需的酮咯酸显著减少（分别为29±16毫克和28±13毫克，而输注0.0625%布比卡因时为110±35毫克；p<0.001）。输注0.125%和0.25%布比卡因时的VAS评分显著低于输注0.0625%布比卡因时的VAS评分。所有患者均未观察到与导管插入相关的运动阻滞或感染情况。
通过弹性输液器持续硬膜外输注0.125%和0.25%布比卡因，在术后最初24小时内可提供良好的镇痛效果。输注0.25%布比卡因时尿潴留的发生率较高。因此，我们认为最推荐的布比卡因输注浓度为0.125%。
