通过胸腔内导管间歇性输注0.25%布比卡因以缓解开胸术后疼痛。

Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief.

作者信息

Tetik Omer, Islamoglu Fatih, Ayan Erhan, Duran Mehmet, Buket Suat, Cekirdekçi Ahmet

机构信息

Department of Cardiovascular Surgery, Atatürk Medical Research Hospital, Izmir, Turkey

出版信息

Ann Thorac Surg. 2004 Jan;77(1):284-8. doi: 10.1016/s0003-4975(03)01338-9.

DOI:10.1016/s0003-4975(03)01338-9

PMID:14726080

Abstract

BACKGROUND

The present study was designed to evaluate the effectiveness of intrapleural 0.25% bupivacaine delivered by intermittent infusions for post-thoracotomy pain relief.

METHODS

Forty patients undergoing elective lobectomy were randomly, but equally, placed into two groups. An intrapleural catheter was inserted under direct vision during surgery. Group I received intrapleural 40 mL of 0.25% bupivacaine, group II was administered 40 mL of saline solution as a control group. Diclofenac sodium was administered as an additional analgesic, if required. Postoperative pain was evaluated using a visual analog scale (VAS), and Prince Henry pain scale. Arterial oxygen saturation, heart rate, and systemic arterial pressures were monitored. All observations were recorded 5, 10, 15, 20, 25, and 30 minutes after the injection, and thereafter at hourly intervals through the postoperative 24 hours.

RESULTS

The mean analgesia times were 5 hours and 2 hours in group I and group II, respectively. Therefore, bupivacaine administrations were repeated every 6 hours in group I, and saline with additional analgesic were administered every 4 hours in group II. The heart rate and arterial pressures did not show a significant difference. While the additional analgesic requirement was 180 +/- 10 mg/d in group II, there was no need for additional analgesic administration in the group I patients. Arterial oxygen was significantly higher in group I than in group II. Arterial carbon dioxide tension of group II was significantly higher than that of group I. While the postoperative atelectasis and pneumonia developed in four patients and one, respectively, in group II, no such complication was observed in group I.

CONCLUSIONS

The easy placement of an intrapleural catheter and better pain relief observed in the present study suggest that intermittent pleural infusion of 0.25% bupivacaine has proven to be a safe and effective method for relief of post-thoracotomy pain.

摘要

背景

本研究旨在评估间歇性输注0.25%布比卡因用于开胸术后镇痛的有效性。

方法

40例行择期肺叶切除术的患者被随机且等分为两组。术中在直视下插入胸膜内导管。第一组接受胸膜内注射40 mL 0.25%布比卡因，第二组作为对照组给予40 mL生理盐水。必要时给予双氯芬酸钠作为辅助镇痛药。采用视觉模拟评分法（VAS）和Prince Henry疼痛评分法评估术后疼痛。监测动脉血氧饱和度、心率和体循环动脉压。在注射后5、10、15、20、25和30分钟记录所有观察结果，此后在术后24小时内每小时记录一次。

结果

第一组和第二组的平均镇痛时间分别为5小时和2小时。因此，第一组每6小时重复给予布比卡因，第二组每4小时给予生理盐水加辅助镇痛药。心率和动脉压无显著差异。第二组辅助镇痛药的需求量为180±10 mg/d，而第一组患者无需额外使用镇痛药。第一组的动脉血氧明显高于第二组。第二组的动脉血二氧化碳分压明显高于第一组。第二组分别有4例和1例发生术后肺不张和肺炎，而第一组未观察到此类并发症。