Nishiyama T, Hirasaki A, Odaka Y, Mikane T, Kobayashi O, Seto K
Department of Anesthesiology, Kagawa Prefectural Central Hospital, Takamatsu.
Masui. 1992 Jul;41(7):1113-8.
Optimal dose of epidural midazolam with bupivacaine for postoperative pain relief was investigated. Forty seven patients for upper abdominal surgery were divided into 5 groups. Each group had either 0.25% bupivacaine 6 ml (control group), 0.25% bupivacaine 6 ml + midazolam 0.025 mg.kg-1 (0.025 group), 0.05 mg.kg-1 (0.05 group), 0.075 mg.kg-1 (0.075 group), or 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of first postoperative pain. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and sedation score (SS) were monitored for 120 minutes, and the time interval for next analgesics (TNA) was checked. In each group, BP fell down 10 minutes after injection, HR was unchanged, and RR (except for 0.1 group) decreased, compared with the preinjection level. There was no difference between control group and others in BP, HR and RR. But 3 cases in 0.075 group and 4 cases in 0.1 group needed chin lift with a pillow under the shoulder for slight airway obstruction. The most optimal SS was obtained in 0.05 group. TNA was significantly longer in 0.025 and 0.05 groups than in the control group. It was concluded that the optimal dose of epidural midazolam with 0.25% bupivacaine 6 ml was 0.05 mg.kg-1 for postoperative pain relief after an upper abdominal surgery.
研究了硬膜外注射咪达唑仑与布比卡因用于术后镇痛的最佳剂量。47例上腹部手术患者被分为5组。每组分别硬膜外注射0.25%布比卡因6毫升（对照组）、0.25%布比卡因6毫升 + 咪达唑仑0.025毫克·千克⁻¹（0.025组）、0.05毫克·千克⁻¹（0.05组）、0.075毫克·千克⁻¹（0.075组）或0.1毫克·千克⁻¹（0.1组）以缓解术后首次疼痛。监测血压（BP）、心率（HR）、呼吸频率（RR）和镇静评分（SS）120分钟，并检查下次使用镇痛药的时间间隔（TNA）。与注射前水平相比，每组注射后10分钟BP下降，HR不变，RR（0.1组除外）降低。对照组与其他组在BP、HR和RR方面无差异。但0.075组有3例和0.1组有4例因轻度气道阻塞需要在肩部下方垫枕头抬起下巴。0.05组获得了最理想的SS。0.025组和0.05组的TNA明显长于对照组。得出结论，对于上腹部手术后的术后镇痛，硬膜外注射0.25%布比卡因6毫升时，咪达唑仑的最佳剂量为0.05毫克·千克⁻¹。
