Axelsson K, Johanzon E, Essving P, Weckström J, Ekbäck G
Department of Anesthesiology & Intensive Care, Orebro University Hospital, Orebro, Sweden.
Acta Anaesthesiol Scand. 2005 Sep;49(8):1191-9. doi: 10.1111/j.1399-6576.2005.00715.x.
Some controversy exists in the literature on the benefit of epidurals compared to patient-controlled intravenous analgesia (PCA). Also, the dose of ropivacaine for epidural analgesia when combined with morphine remains uncertain. The aim of this study was to compare the epidural vs. PCA technique and high-dose vs. low-dose ropivacaine combined with morphine during knee replacement surgery.
In this prospective, randomized, double-blind study, postoperative pain relief with a combination of epidural ropivacaine (Group L: 10 mg h-1, Group H: 16 mg h-1) and morphine (0.16 mg h-1) was evaluated in 30 patients. A placebo group (Group PL) of 15 patients having PCA morphine served as the control. Visual analog pain (VAS), morphine consumption, sensory and motor block and side-effects were recorded during 48 h.
VAS scores at rest were significantly lower in Groups L and H compared to Group PL. On movement, Group H had lower VAS scores than Group PL during 3-27 h (P<0.05) and Group L during 4-9 h (P<0.05), while Group L had lower a VAS than Group PL during 9-18 h (P<0.05). Morphine consumption after 48 h was greater in Group PL (64.6+/-36.3 mg) vs. Group L (23.3+/-33.9 mg) (P<0.001) and Group H (4.3+/-9.6 mg) (P<0.0001). Mild motor block was seen in Group H in 20% and 14% patients at 24 h and 48 h, respectively, but time to mobilization was similar between the groups. Pruritus was more common in the ropivacaine groups (P<0.05).
Lumbar epidural analgesia using a combination of ropivacaine (16 mg h-1) and morphine (0.16 mg h-1) provides superior analgesia compared to the PCA technique or ropivacaine (10 mg h-1) and morphine (0.16 mg h-1). Although this resulted in a mild motor block during the first 12 h, patient mobilization was similar in all groups.
与患者自控静脉镇痛（PCA）相比，硬膜外镇痛的益处，文献中存在一些争议。此外，罗哌卡因与吗啡联合用于硬膜外镇痛时的剂量仍不确定。本研究的目的是比较膝关节置换手术期间硬膜外镇痛与PCA技术，以及高剂量与低剂量罗哌卡因联合吗啡的效果。
在这项前瞻性、随机、双盲研究中，对30例患者使用硬膜外罗哌卡因（L组：10mg/h，H组：16mg/h）和吗啡（0.16mg/h）联合进行术后疼痛缓解评估。15例使用PCA吗啡的患者作为安慰剂组（PL组）。记录48小时内的视觉模拟疼痛（VAS）、吗啡用量、感觉和运动阻滞以及副作用。
与PL组相比，L组和H组静息时的VAS评分显著更低。活动时，H组在3至27小时内的VAS评分低于PL组（P<0.05），在4至9小时内低于L组（P<0.05），而L组在9至18小时内的VAS评分低于PL组（P<0.05）。48小时后，PL组（64.6±36.3mg）的吗啡用量大于L组（23.3±33.9mg）（P<0.001）和H组（4.3±9.6mg）（P<0.0001）。H组分别有20%和14%的患者在24小时和48小时出现轻度运动阻滞，但各组之间的活动时间相似。瘙痒在罗哌卡因组中更常见（P<0.05）。
与PCA技术或罗哌卡因（10mg/h）和吗啡（0.16mg/h）相比，使用罗哌卡因（16mg/h）和吗啡（0.16mg/h）联合进行腰椎硬膜外镇痛提供了更好的镇痛效果。虽然这在最初12小时内导致了轻度运动阻滞，但所有组的患者活动情况相似。
