Zohar Edna, Shapiro Arie, Phillipov Alex, Hoppenstein David, Klein Zvi, Fredman Brian
Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba, Israel.
J Clin Anesth. 2004 Sep;16(6):399-404. doi: 10.1016/j.jclinane.2004.07.002.
To assess the influence of ropivacaine concentration on wound instillation-induced postoperative analgesia following total abdominal hysterectomy with bilateral salpingo-oophorectomy.
Prospective, randomized, double-blind study.
Large referral hospital.
40 ASA physical status I and II patients undergoing total abdominal hysterectomy with bilateral salpingo-oophorectomy.
A standard general anesthetic was administered. In all cases surgery was performed via a Pfannenstiel incision. On completion of the surgery, a multi-orifice, 20-gauge epidural catheter was placed above the fascia such that the tip was sited at the point that demarcated 50% of the length of the surgical wound. Thereafter, the catheter was connected to an electronic patient-controlled analgesia (PCA) device programmed to deliver 9 mL of drug, with a lockout time of 60 minutes and no basal infusion. Patients were randomized to receive PCA with ropivacaine 0.1% (Group 0.1) or ropivacaine 0.2% (Group 0.2). During the first 6 postoperative hours, a co-investigator administered "rescue" morphine (2 mg IV). Thereafter, "rescue" meperidine 1 mg/kg was administered on patient request.
The number of attempts to activate the PCA device and actual PCA instillations during the 24 hour study period were similar between the groups. The number of 2 mg "rescue" morphine dosages administered was 4.3 +/- 1.7 versus 4.4 +/- 2.5 for the Group 0.1 and Group 0.2, respectively. For Group 0.1 and Group 0.2, the total dose of "rescue" morphine administered during the first 6 postoperative hours was 8.7 mg +/- 3.6 versus 9.1 mg +/- 5, respectively. "Rescue" meperidine administration during the subsequent 18 hours was similar between the groups. Throughout the study period, pain scores were similar between the groups.
With a pre-set volume, varying the concentration of ropivacaine (0.1% versus 0.2%) does not affect the analgesic efficacy of wound instillation following total abdominal hysterectomy with bilateral salpingo-oophorectomy.
评估罗哌卡因浓度对全腹子宫切除联合双侧输卵管卵巢切除术后伤口滴注诱导的术后镇痛效果的影响。
前瞻性、随机、双盲研究。
大型转诊医院。
40例美国麻醉医师协会（ASA）身体状况为I级和II级、接受全腹子宫切除联合双侧输卵管卵巢切除术的患者。
给予标准全身麻醉。所有病例均经耻骨联合上横切口进行手术。手术结束后，在筋膜上方放置一根多孔20号硬膜外导管，使其尖端位于手术伤口长度50%的分界点处。此后，将导管连接至电子患者自控镇痛（PCA）装置，该装置设定为输注9 mL药物，锁定时间为60分钟，无基础输注。患者被随机分为接受0.1%罗哌卡因PCA（0.1组）或0.2%罗哌卡因PCA（0.2组）。术后前6小时内，由一名共同研究者给予“解救”吗啡（静脉注射2 mg）。此后，根据患者需求给予“解救”哌替啶1 mg/kg。
在24小时研究期间，两组激活PCA装置的尝试次数和实际PCA滴注次数相似。0.1组和0.2组给予2 mg“解救”吗啡的剂量分别为4.3±1.7次和4.4±2.5次。对于0.1组和0.2组，术后前6小时给予的“解救”吗啡总剂量分别为8.7 mg±3.6 mg和9.1 mg±5 mg。两组在随后18小时内给予“解救”哌替啶的情况相似。在整个研究期间，两组的疼痛评分相似。
在预设容量的情况下，改变罗哌卡因浓度（0.1%与0.2%）并不影响全腹子宫切除联合双侧输卵管卵巢切除术后伤口滴注的镇痛效果。
