Kammoun Walid, Mestiri Tahar, Miraoui Walid, Frikha Nabil, Mebazaa Mhamed Sami, Kilani Tarak, Ben Ammar Mohamed Salah
Service d'Anesthésie-Réanimation, CHU Mongi Slim, La Marsa,Tunisie.
Tunis Med. 2008 Feb;86(2):144-9.
To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery.
Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods. Group 1 (n=22) received patient control analgesia Group 2 (n=22) received continuous epidural analgesia (Bupivacaine 0,125% + 5 microg/ml of Fentanyl) between 6 and 10 ml/h in order to obtain a T2 level Group 3 (n=22) received patient controlled epidural analgesia (Bupivacaine 0,08% + 3 microg/ml of Fentanyl) 6 ml/h and bolus of 5 ml.
There was no difference between the three groups in age, delay of surgical operation and per operative morphine consumption. VAS was less at rest and after cough in patient group with patient controlled epidural analgesia. The difference was less significant in local anaesthetics and opioids consumption in patient with controlled epidural analgesia.
The benefit of patient controlled epidural analgesia in thoracic surgery is proven by the following analgesic efficiency which allows good respiratory rehabilitation, decreasing the risk of drug toxicity by decreases consumption, weak hemodynamic effects and absence of motor block.
比较连续硬膜外镇痛、患者自控镇痛和患者自控硬膜外镇痛在胸外科手术中的疼痛控制效果、局部麻醉药和阿片类药物的消耗量以及副作用。
前瞻性随机研究纳入了66例行开胸手术的患者。患者被分为3组，接受不同的疼痛控制方法。第1组（n = 22）接受患者自控镇痛；第2组（n = 22）接受连续硬膜外镇痛（0.125%布比卡因+5微克/毫升芬太尼），以6至10毫升/小时的速度给药，以达到T2水平；第3组（n = 22）接受患者自控硬膜外镇痛（0.08%布比卡因+3微克/毫升芬太尼），6毫升/小时，推注量为5毫升。
三组在年龄、手术延迟时间和术中吗啡消耗量方面无差异。在休息和咳嗽后，患者自控硬膜外镇痛组的视觉模拟评分（VAS）较低。在接受自控硬膜外镇痛的患者中，局部麻醉药和阿片类药物的消耗量差异较小。
患者自控硬膜外镇痛在胸外科手术中的益处通过以下镇痛效果得到证实：良好的呼吸康复效果、通过减少药物消耗量降低药物毒性风险、轻微的血流动力学影响以及无运动阻滞。
