Schulze S, Sommer P, Bigler D, Honnens M, Shenkin A, Cruickshank A M, Bukhave K, Kehlet H
Department of Surgical Gastroenterology F, Bispebjerg University Hospital, Copenhagen, Denmark.
Arch Surg. 1992 Mar;127(3):325-31. doi: 10.1001/archsurg.1992.01420030095018.
Twenty patients undergoing colonic resection were randomized to either conventional postoperative pain treatment with morphine chloride and acetaminophen (group 1, n = 9) or methylprednisolone sodium succinate 90 minutes before surgery plus intraoperative neural blockade, with a postoperative analgesic regimen with combined bupivacaine hydrochloride-morphine and indomethacin sodium for systemic effect (group 2, n = 11). Assessments of pain, pulmonary function, convalescence, and various injury factors were done several times until 8 days after surgery. Postoperative pain and hyperthermic response were eliminated in group 2. Conventional reduction in pulmonary function measures was improved in group 2, and fatigue and mobility were less pronounced. Prostaglandin E2, interleukin 6, and C-reactive protein levels increased in both groups, but significantly less in group 2. These results suggest that a combined neural and humoral blockade may more effectively inhibit the global stress response to elective surgery than previously observed with neural blockade with or without indomethacin.
20例行结肠切除术的患者被随机分为两组，一组采用常规术后疼痛治疗，即使用氯化吗啡和对乙酰氨基酚（第1组，n = 9）；另一组在手术前90分钟给予琥珀酸钠甲泼尼龙并联合术中神经阻滞，术后采用盐酸布比卡因 - 吗啡和吲哚美辛钠联合镇痛方案以达到全身效应（第2组，n = 11）。在术后8天内多次进行疼痛、肺功能、恢复情况及各种损伤因素的评估。第2组术后疼痛和发热反应消除。第2组肺功能指标的常规降低情况得到改善，疲劳和活动受限程度减轻。两组患者的前列腺素E2、白细胞介素6和C反应蛋白水平均升高，但第2组升高幅度明显较小。这些结果表明，与单纯神经阻滞（无论是否联合吲哚美辛）相比，神经和体液联合阻滞可能更有效地抑制择期手术的全身应激反应。
