Hepato-biliary Unit, North Hampshire Hospital, Basingstoke, UK.
HPB (Oxford). 2004;6(3):186-9. doi: 10.1080/13651820410030844.
Epidural analgesia is considered one of the optimal methods for provision of postoperative pain relief in patients recovering from major upper abdominal operations. Concerns regarding the potential risk of neurological complications prompted an evaluation of an alternative strategy using a continuous intermuscular bupivacaine (CIB) infusion combined with patient-controlled analgesia (PCA).
Two fine-bore catheters are inserted in the deep intermuscular intercostal neuronal plane during abdominal wound closure, and a continuous infusion of bupivacaine 0.25% is commenced for 72 h postoperatively. Simultaneously, patient-controlled analgesia provided intravenous morphine on demand. The study comprised 10 consecutive patients undergoing liver resection in whom CIB infusion and PCA were employed. The feasibility, safety and efficacy of the technique were investigated, analysing postoperative pain scores, morphine requirements, spirometry and oxygen saturation.
There were no postoperative deaths. Postoperative morbidity included one urinary tract infection, one minor chest infection and acute confusional episodes in two patients. Median pain scores and morphine requirements at 12, 24, 48 and 72 h postoperatively were satisfactory. Spirometry and oxygen saturation values also remained within the normal range.
Preliminary experience with CIB infusion/PCA in the aftermath of major liver resection has demonstrated its simplicity and safety as an alternative method of postoperative pain control. Further study is required to investigate the role of CIB infusion/PCA as a practical alternative to epidural analgesia or PCA alone.
硬膜外镇痛被认为是缓解上腹部大手术后患者术后疼痛的最佳方法之一。由于担心可能存在神经并发症的风险，因此评估了一种替代策略，即使用连续肌间布比卡因（CIB）输注联合患者自控镇痛（PCA）。
在腹部伤口关闭过程中，将两根细导管插入深部肌间肋间神经元平面，并在术后 72 小时内开始输注 0.25%布比卡因的连续输注。同时，按需提供静脉注射吗啡的 PCA。本研究包括 10 例连续接受肝切除术的患者，采用 CIB 输注和 PCA。分析术后疼痛评分、吗啡需求、肺活量和血氧饱和度，研究了该技术的可行性、安全性和有效性。
无术后死亡。术后发病率包括 1 例尿路感染、1 例轻度肺部感染和 2 例患者出现急性意识混乱。术后 12、24、48 和 72 小时的中位数疼痛评分和吗啡需求均令人满意。肺活量和血氧饱和度值也在正常范围内。
在大肝切除术后使用 CIB 输注/PCA 的初步经验表明，它是一种替代术后疼痛控制的简单而安全的方法。需要进一步研究以调查 CIB 输注/PCA 作为硬膜外镇痛或单独 PCA 的实用替代方法的作用。
