Kampe S, Diefenbach C, Kanis B, Auweiler M, Kiencke P, Cranfield K
University of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Germany.
Eur J Anaesthesiol. 2002 Sep;19(9):666-71. doi: 10.1017/s0265021502001096.
We assessed the analgesic efficacy of postoperative epidural infusions of ropivacaine 0.1 and 0.2% combined with sufentanil 1 microg mL(-1) in a prospective, randomized, double-blinded study.
Twenty-two ASA I-III patients undergoing elective total-knee replacement were included. Lumbar epidural blockade using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. After surgery, the epidural infusion was commenced. Eleven patients in each group received either an epidural infusion of ropivacaine 0.1% with 1 microg mL(-1) sufentanil (Group 1) or ropivacaine 0.2% with 1 microg mL(-1) sufentanil (Group 2) at a rate of 5-9 mL h(-1). All patients had access to intravenous pirinatrimide (piritramide) via a patient-controlled analgesia (PCA) device.
Motor block was negligible for the study duration in both groups. There was no significant difference with the 100 mm visual analogue scale (VAS) scores, with the consumption of rescue analgesia or with patient satisfaction. Patients in Group 1 experienced significantly less nausea (P < 0.05) than those in Group 2. Both treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA.
We recommend the use of ropivacaine 0.1% with 1 microg mL(-1) sufentanil for postoperative analgesia after total knee replacement as it provides efficient pain relief with no motor block of the lower limbs. In addition, compared with 0.2% ropivacaine with sufentanil, the mixture reduces local anaesthetic consumption without compromise in patient satisfaction or VAS scores. Patients even experience less nausea.
在一项前瞻性、随机、双盲研究中，我们评估了术后硬膜外输注0.1%和0.2%罗哌卡因联合1微克/毫升舒芬太尼的镇痛效果。
纳入22例接受择期全膝关节置换术的美国麻醉医师协会（ASA）I - III级患者。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11例患者分别接受以5 - 9毫升/小时的速率硬膜外输注0.1%罗哌卡因加1微克/毫升舒芬太尼（第1组）或0.2%罗哌卡因加1微克/毫升舒芬太尼（第2组）。所有患者均可通过患者自控镇痛（PCA）装置静脉注射匹利卡明（匹利米特）。
两组在研究期间运动阻滞可忽略不计。在100毫米视觉模拟量表（VAS）评分、补救性镇痛药物用量或患者满意度方面无显著差异。第1组患者恶心的发生率明显低于第2组（P < 0.05）。两种治疗方案均提供了有效的术后镇痛，且仅少量使用补充性阿片类PCA。
我们推荐在全膝关节置换术后使用0.1%罗哌卡因加1微克/毫升舒芬太尼进行术后镇痛，因为它能有效缓解疼痛且不会导致下肢运动阻滞。此外，与0.2%罗哌卡因加舒芬太尼相比，该混合药物减少了局部麻醉药的用量，而不影响患者满意度或VAS评分。患者甚至恶心症状更少。
