Wang Qiong, She Shou-zhang, Zhang Yong-fu, Lao Jian-xin, Jin Yu-lin
Department of Anesthesiology, Women and Children's Hospital of Guangzhou, Guangzhou, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2008 Aug;28(8):1474-6.
To investigate the effect of sufentanil administered intrathecally at different doses on the clinical effect of bupivacaine spinal anesthesia in gynecologic laparoscopy.
Sixty patients with ectopic pregnancy undergoing elective laparoscopy (ASA class I-II) were randomized into 4 groups (groups A, B, C and D), and received spinal anesthesia with 15 mg bupivacaine and sufentanil at 0, 2.5, 5 and 7.5 microg, respectively. When the patients complained of discomforts, showed bodily movements, had heart rate over 100 beats/min, or showed blood pressure increment by 20%, additional doses of propofol were given. The onset time of sensory block, time to Bromage scale 3 motor block, time to the highest sensory block level, time of operation and recovery from anesthesia, and the total dosages of propofol were recorded along with the sedative score and the side effects.
The 4 groups were comparable for age, body weight, height and operation time (range 60-65 min) (P>0.05). Both the onset time of sensory block and the time of Bromage scale 3 motor block in groups C and D were significantly shorter than those in groups A and B (P<0.05). The time of the highest sensory block in group D was shorter than that in group A (P<0.05). Compared to the group A, the dose of propofol was reduced in groups B, C, and D by 7.1%, 28.1%, and 34.8%, respectively; propofol doses in groups C and D were significantly lower than those in groups A and B (P<0.05). Pruritus associated with the spinal anesthesia occurred in 4 (26.7%), 3 (20%), and 6 (40%) cases in groups B, C and D, respectively.
Intrathecal sufentanil dose-dependently affect the effect of bupivacaine spinal anesthesia, and larger sufentanil dose produces better effects but more side effects. According to our results, 5.0 microg is the optimal dose for sufentanil.
探讨不同剂量舒芬太尼鞘内注射对妇科腹腔镜手术中布比卡因腰麻临床效果的影响。
将60例行择期腹腔镜手术的异位妊娠患者（ASA分级I-II级）随机分为4组（A组、B组、C组和D组），分别接受含0、2.5、5和7.5微克舒芬太尼的15毫克布比卡因腰麻。当患者主诉不适、出现身体活动、心率超过100次/分钟或血压升高20%时，给予额外剂量的丙泊酚。记录感觉阻滞起效时间、布罗玛分级3级运动阻滞时间、最高感觉阻滞平面时间、手术时间和麻醉恢复时间，以及丙泊酚总用量、镇静评分和副作用。
4组患者的年龄、体重、身高和手术时间（范围60-65分钟）具有可比性（P>0.05）。C组和D组的感觉阻滞起效时间和布罗玛分级3级运动阻滞时间均显著短于A组和B组（P<0.05）。D组的最高感觉阻滞平面时间短于A组（P<0.05）。与A组相比，B组、C组和D组的丙泊酚用量分别减少了7.1%、28.1%和34.8%；C组和D组的丙泊酚用量显著低于A组和B组（P<0.05）。B组、C组和D组分别有4例（26.7%）、3例（20%）和6例（40%）发生与腰麻相关的瘙痒。
鞘内注射舒芬太尼对布比卡因腰麻效果有剂量依赖性影响，舒芬太尼剂量越大效果越好，但副作用越多。根据我们的结果，5.0微克是舒芬太尼的最佳剂量。
