Joshi V S, Chauhan Sandeep, Kiran Usha, Bisoi A K, Kapoor Poonam Malhotra
Department of Cardiothoracic & Vascular Anaesthesia, All India Institute of Medical Sciences, New Delhi.
Ann Card Anaesth. 2007 Jan;10(1):42-5. doi: 10.4103/0971-9784.37923.
Chest tube removal in the postcardiac surgical patients is a painful and distressful event. Fentanyl and sufentanil have not been used for pain control during chest tube removal in the postoperative period. We compared efficacy offentanyl and sufentanil in controlling pain due to chest tube removal. One hundred and forty one adult patients undergoing cardiac surgery were recruited in a prospective, randomized, double blind, placebo controlled study. Patients were randomized to receive either 2 microg/Kg fentanyl IV or 0.2 microg/Kg sufentanil IV or 2 ml isotonic normal saline, 10 min before removing chest tubes. Pain intensity was assessed by measuring visual analog scale pain score 10 minutes before removing chest tubes and 5 min and 20 min after removing chest tubes. Level of sedation, heart rate, arterial pressure, oxygen saturation, and respiratory rate were recorded by a blinded observer at the same time intervals. Mean pain intensity scores 10 minutes before removal of chest tubes infentanyl, sufentanil and control groups were 23.88+/-5.2, 25.10+/-5.39 and 23.64+/-6.10 respectively. The pain scores 5 minutes after chest tube removal were reduced to 20.11+/-6.9 (p<0.05) in the fentanyl group and 13.60+/-6.60 (p<0.05) in the sufentanil group, whereas in control group pain scores increased to 27.97+/-8.39 (p<O.05). The pain scores in sufentanil group were significantly lower compared with fentanyl or control group. Sedation scores remained low in all groups and patients remained alert and none of the patients showed any adverse effects of opioids. Heart rate, arterial pressure and respiratory rate had least variations in sufentanil group than fentanyl or control group.
心脏手术后患者拔除胸管是一个痛苦且令人困扰的过程。在术后拔除胸管期间，芬太尼和舒芬太尼尚未用于控制疼痛。我们比较了芬太尼和舒芬太尼在控制胸管拔除所致疼痛方面的疗效。一项前瞻性、随机、双盲、安慰剂对照研究纳入了141例接受心脏手术的成年患者。患者在拔除胸管前10分钟被随机分为接受2μg/kg静脉注射芬太尼、或0.2μg/kg静脉注射舒芬太尼、或2ml等渗生理盐水。在拔除胸管前10分钟、拔除胸管后5分钟和20分钟，通过测量视觉模拟量表疼痛评分来评估疼痛强度。由一位不知情的观察者在相同时间间隔记录镇静水平、心率、动脉压、血氧饱和度和呼吸频率。芬太尼组、舒芬太尼组和对照组在拔除胸管前10分钟的平均疼痛强度评分分别为23.88±5.2、25.10±5.39和23.64±6.10。芬太尼组在拔除胸管后5分钟时疼痛评分降至20.11±6.9（p<0.05），舒芬太尼组降至13.60±6.60（p<0.05），而对照组疼痛评分升至27.97±8.39（p<0.05）。舒芬太尼组的疼痛评分显著低于芬太尼组或对照组。所有组的镇静评分均较低，患者保持清醒，且无一例患者出现阿片类药物的任何不良反应。与芬太尼组或对照组相比，舒芬太尼组的心率、动脉压和呼吸频率变化最小。
