Dernedde M, Stadler M, Bardiau F, Seidel L, Boogaerts J G
Department of Anaesthesiology, University Hospital Centre, Charleroi, Belgium.
Acta Anaesthesiol Scand. 2006 May;50(5):613-21. doi: 10.1111/j.1399-6576.2006.001004.x.
Although the use of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) has become commonplace in pain management, there is still controversy regarding the relative effects of mass, volume and concentration of the local anaesthetic. This prospective study evaluated the influence of two concentrations of levobupivacaine on the quality of analgesia in two modes of delivery after lower abdominal surgery.
Eighty-two patients were randomly assigned to four groups to receive combined low thoracic epidural analgesia and general anaesthesia followed by post-operative CEI or PCEA using 1.5 or 5 mg/ml levobupivacaine (15 mg/h in CEI and bolus 5 mg, lockout 20 min in PCEA). Sensory block, pain scores, levobupivacaine and rescue morphine consumption, motor blockade, haemodynamics, side-effects and patient satisfaction were registered within 48 h.
The four groups were similar with regard to demographics, quality of analgesia, morphine consumption and satisfaction rate. No difference in the quality of analgesia was observed for the two modes of delivery with regard to the concentration of levobupivacaine, but the consumption of the local anaesthetic was higher in the CEI groups. The Bromage scores in the PCEA groups were reduced to zero for all except one patient, whereas eight patients presented scores of one or more in the CEI population.
Levobupivacaine in thoracic epidurals provides an equal quality of post-operative analgesia in low and high volume independent of the delivery mode, i.e. CEI or PCEA. This is in accordance with the assumption that the total dose of the local anaesthetic determines the quality of analgesia.
尽管持续硬膜外输注（CEI）和患者自控硬膜外镇痛（PCEA）在疼痛管理中已很常见，但关于局部麻醉药的质量、容量和浓度的相对影响仍存在争议。这项前瞻性研究评估了两种浓度的左旋布比卡因在下腹部手术后两种给药方式下对镇痛质量的影响。
82例患者被随机分为四组，接受胸段硬膜外镇痛联合全身麻醉，术后使用1.5或5mg/ml左旋布比卡因进行CEI或PCEA（CEI为15mg/h，PCEA为单次推注5mg，锁定时间20分钟）。在48小时内记录感觉阻滞、疼痛评分、左旋布比卡因和补救性吗啡的消耗量、运动阻滞、血流动力学、副作用和患者满意度。
四组在人口统计学、镇痛质量、吗啡消耗量和满意率方面相似。对于两种给药方式，左旋布比卡因浓度对镇痛质量没有差异，但CEI组局部麻醉药的消耗量更高。除一名患者外，PCEA组的布罗麻评分均降至零，而CEI组有八名患者的评分为一分或更高。
胸段硬膜外使用左旋布比卡因，无论给药方式是CEI还是PCEA，低容量和高容量下术后镇痛质量相同。这与局部麻醉药的总剂量决定镇痛质量的假设一致。
