Macias Antonio, Monedero Pablo, Adame María, Torre Wenceslao, Fidalgo Isabel, Hidalgo Francisco
Department of Anesthesia and Critical Care, Clinica Universitaria, University of Navarre, Navarre, Spain.
Anesth Analg. 2002 Nov;95(5):1344-50, table of contents. doi: 10.1097/00000539-200211000-00046.
Epidural ropivacaine has not been compared with bupivacaine for postthoracotomy analgesia. Eighty patients undergoing elective lung surgery were randomized in a double-blinded manner to receive one of three solutions for high thoracic epidural analgesia. A continuous epidural infusion of 0.1 mL. kg(-1). h(-1) of either 0.2% ropivacaine, 0.15% ropivacaine/fentanyl 5 micro g/mL, or 0.1% bupivacaine/fentanyl 5 micro g/mL was started at admission to the intensive care unit. We assessed pain scores (rest and spirometry), IV morphine consumption, spirometry, hand grip strength, PaCO(2), heart rate, blood pressure, respiratory rate, and side effects (sedation, nausea, vomiting, and pruritus) for 48 h. Thoracic epidural ropivacaine/fentanyl provided adequate pain relief similar to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. The use of plain 0.2% ropivacaine was associated with worse pain control during spirometry, larger consumption of IV morphine, and increased incidence of postoperative nausea and vomiting. Morphine requirements were larger in the ropivacaine group, with no differences between bupivacaine/fentanyl and ropivacaine/fentanyl groups. Patients in the ropivacaine group experienced more pain and performed worse in spirometry than patients who received epidural fentanyl. There was no significant difference in motor block. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.
Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.
尚未将硬膜外罗哌卡因与布比卡因用于开胸术后镇痛进行比较。80例行择期肺手术的患者被双盲随机分组，接受三种用于高位胸段硬膜外镇痛溶液中的一种。在进入重症监护病房时开始持续硬膜外输注0.2%罗哌卡因、0.15%罗哌卡因/芬太尼5μg/mL或0.1%布比卡因/芬太尼5μg/mL，速率为0.1 mL·kg⁻¹·h⁻¹。我们评估了48小时内的疼痛评分（静息和肺活量测定时）、静脉注射吗啡用量、肺活量测定、握力、动脉血二氧化碳分压、心率、血压、呼吸频率以及副作用（镇静、恶心、呕吐和瘙痒）。在后外侧开胸术后的头2天，胸段硬膜外罗哌卡因/芬太尼提供了与布比卡因/芬太尼相似的充分疼痛缓解。使用单纯0.2%罗哌卡因与肺活量测定时疼痛控制较差、静脉注射吗啡用量较大以及术后恶心和呕吐发生率增加有关。罗哌卡因组的吗啡需求量较大，布比卡因/芬太尼组和罗哌卡因/芬太尼组之间无差异。与接受硬膜外芬太尼的患者相比，罗哌卡因组患者疼痛更明显，肺活量测定表现更差。运动阻滞无显著差异。我们得出结论，对于开胸术后镇痛，硬膜外罗哌卡因/芬太尼与布比卡因/芬太尼相比无临床优势。
在后外侧开胸术后的头2天，胸段硬膜外罗哌卡因/芬太尼提供了与布比卡因/芬太尼相似的充分疼痛缓解和镇痛效果。单纯0.2%罗哌卡因与疼痛控制较差和术后恶心呕吐发生率增加有关。我们得出结论，对于开胸术后镇痛，硬膜外罗哌卡因/芬太尼与布比卡因/芬太尼相比无临床优势。
