Tobias J D
Department of Anesthesiology/Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN.
South Med J. 1991 Dec;84(12):1458-61. doi: 10.1097/00007611-199112000-00012.
The cohort for this study included 39 patients, between the ages of 8 and 20 years, who had had thoracotomy. Postoperative analgesia was provided by one of three techniques: intravenous narcotics (20 patients), thoracic epidural catheter (10 patients), or interpleural analgesia (IPA) (nine patients). Both IPA and epidural analgesia were administered according to a specific protocol. The efficacy of the three methods was evaluated using two indicators: the total intravenous narcotic requirements for the initial 72 hours and the number of times a dose of intravenous narcotic or supplemental epidural fentanyl was administered to each patient. Patients in the IPA group required significantly less intravenous narcotics (P less than .05) during the first three postoperative days (2.2 +/- 0.4, 1.9 +/- 0.6, and 1.4 +/- 0.5 mg of meperidine/kg/day) than patients in the intravenous narcotic group (8.1 +/- 1.2, 7.2 +/- 0.9, and 5.6 +/- 1.2 mg of meperidine/kg/day). When comparing epidural analgesia and IPA, the number of interventions in the patients receiving epidural analgesia was significantly less (P less than .05) than in the group receiving IPA. Four of 10 patients in the epidural group and two of nine in the IPA group required no interventions during the initial 72-hour postoperative course. In the epidural analgesia group, there were 19 days (of a total of 30 days) during which patients required no interventions. This percentage was significantly greater (P less than .05) than that of the IPA group, in which there were 9 days (of a total of 27 days), during which no interventions were required.
本研究的队列包括39例年龄在8至20岁之间接受过开胸手术的患者。术后镇痛采用以下三种技术之一：静脉注射麻醉剂（20例患者）、胸段硬膜外导管（10例患者）或肋间镇痛（IPA）（9例患者）。IPA和硬膜外镇痛均按照特定方案进行给药。使用两个指标评估这三种方法的疗效：最初72小时的静脉麻醉剂总需求量以及每位患者静脉注射麻醉剂或补充硬膜外芬太尼的给药次数。IPA组患者在术后头三天（哌替啶2.2±0.4、1.9±0.6和1.4±0.5mg/千克/天）所需的静脉麻醉剂明显少于静脉麻醉剂组患者（8.1±1.2、7.2±0.9和5.6±1.2mg/千克/天）（P小于0.05）。比较硬膜外镇痛和IPA时，接受硬膜外镇痛的患者的干预次数明显少于接受IPA的组（P小于0.05）。硬膜外组10例患者中有4例，IPA组9例患者中有2例在术后最初72小时疗程中无需干预。在硬膜外镇痛组中，患者在总共30天中有19天无需干预。该百分比明显高于IPA组（P小于0.05），IPA组在总共27天中有9天无需干预。
