Akrofi Maria, Miller Scott, Colfar Steve, Corry Peter R, Fabri Brian M, Pullan Mark D, Russell Glenn N, Fox Mark A
Cardiothoracic Centre National Health Service Trust, Thomas Drive, Liverpool, United Kingdom.
Anesth Analg. 2005 Jan;100(1):205-209. doi: 10.1213/01.ANE.0000140237.96510.E5.
Sixty-six patients scheduled for coronary artery bypass graft and/or valve surgery were recruited in a prospective, randomized study designed to compare the effectiveness of three analgesic regimens for chest drain removal. Patients were randomized to receive 0.1 mg/kg IV morphine, 20 mL of 0.5% bupivacaine infiltrated subcutaneously, or inhaled 50% nitrous oxide in oxygen (Entonox) via a demand valve. We assessed pain by measuring visual analog scale pain scores before and during drain removal. Median (25th, 75th centile) visual analog scale pain scores associated with drain removal in the bupivacaine, Entonox, and morphine groups were 9.5 mm (3, 18 mm), 37.0 mm (13, 56 mm), and 15.0 mm (7, 27 mm), respectively. The pain scores were higher in the Entonox group compared with the bupivacaine group (P=0.005) and the morphine group (P=0.047). Differences between baseline and drain-removal scores were -0.5 mm (-13, 7 mm), +10 mm (1, 29 mm), and -3.0 mm (-11, 12 mm), respectively. There was no difference among groups in arterial blood pressure, heart rate, PaCO2, oxygenation, or sedation. Bupivacaine and morphine, unlike Entonox, produce lower pain scores associated with drain removal.
66例计划进行冠状动脉搭桥术和/或瓣膜手术的患者被纳入一项前瞻性随机研究，该研究旨在比较三种镇痛方案在拔除胸腔引流管时的有效性。患者被随机分为三组，分别接受静脉注射0.1mg/kg吗啡、皮下注射20ml 0.5%布比卡因或通过按需阀吸入50%氧化亚氮和氧气的混合气体（恩托诺克斯）。我们通过测量拔除引流管前和拔除过程中的视觉模拟量表疼痛评分来评估疼痛程度。布比卡因组、恩托诺克斯组和吗啡组与拔除引流管相关的视觉模拟量表疼痛评分中位数（第25、75百分位数）分别为9.5mm（3，18mm）、37.0mm（13，56mm）和15.0mm（7，27mm）。恩托诺克斯组的疼痛评分高于布比卡因组（P = 0.005）和吗啡组（P = 0.047）。基线和拔除引流管时的评分差异分别为-0.5mm（-13，7mm）、+10mm（1，29mm）和-3.0mm（-11，12mm）。三组在动脉血压、心率、动脉血二氧化碳分压、氧合或镇静方面没有差异。与恩托诺克斯不同，布比卡因和吗啡在拔除引流管时产生的疼痛评分更低。
