Wu Christopher L, Cohen Seth R, Richman Jeffrey M, Rowlingson Andrew J, Courpas Genevieve E, Cheung Kristin, Lin Elaina E, Liu Spencer S
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Anesthesiology. 2005 Nov;103(5):1079-88; quiz 1109-10. doi: 10.1097/00000542-200511000-00023.
The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.
作者进行了一项荟萃分析，发现与静脉自控镇痛相比，硬膜外镇痛总体上能提供更优的术后镇痛效果。对于所有类型的手术和疼痛评估，除了仅使用亲水性阿片类药物的硬膜外方案外，所有形式的硬膜外镇痛（持续硬膜外输注和自控硬膜外镇痛）与静脉自控镇痛相比，均能提供显著更优的术后镇痛效果。对于总体疼痛、静息时疼痛和活动时疼痛，持续硬膜外输注在统计学上提供了比自控硬膜外镇痛显著更优的镇痛效果；然而，接受持续硬膜外输注的患者恶心呕吐和运动阻滞的发生率显著更高，但瘙痒发生率更低。总之，几乎无一例外，无论镇痛药物、硬膜外方案以及疼痛评估的类型和时间如何，硬膜外镇痛与静脉自控镇痛相比，都能提供更优的术后镇痛效果。
