Boidin M P, Sulimma H, Hamers S E
Dept. Anesthesiology, Ignatius Hospital Breda, The Netherlands.
Acta Anaesthesiol Belg. 1991;42(2):93-9.
The efficacy of epidural mepivacaine and bupivacaine, combined with fentanyl to enhance blockade, was compared in two parallel controlled, double-blind clinical trials. Patients in the studies (n = 91) were scheduled for orthopedic surgery of the legs and a tourniquet was used in all cases. Those patients receiving mepivacaine attended day surgery only, whereas patients receiving bupivacaine were hospitalised. Epidural puncture was performed with a Tuohy needle at the L3-4 level in the lateral decubitus position. Levels of sensory and motor blockade were assessed; adverse reactions and pain during surgery were recorded. There were four groups of patients: 1) 26 received 2% mepivacaine with placebo; 2) 26 received 2% mepivacaine with 0.1 mg fentanyl; 3) 19 received 0.5% bupivacaine with placebo and 4) 20 patients received 0.5% bupivacaine with 0.1 mg fentanyl. The levels of the sensory blockade was comparable in all groups. The degree of motor-blockade was more intense in the mepivacaine groups, but the blockade by mepivacaine lasted shorter. Addition of fentanyl did not change the sensory and motor blockade. Intraoperative pain was reported by: 7 patients in the mepivacaine/placebo group; 4 patients in the mepivacaine/fentanyl group; 4 patients in the bupivacaine/placebo group; and by one patient in the bupivacaine/fentanyl group. These results indicate that fentanyl enhances the quality of epidural blockade when combined with either mepivacaine or bupivacaine.
在两项平行对照、双盲临床试验中，比较了硬膜外注射甲哌卡因和布比卡因，并联合芬太尼以增强阻滞效果。研究中的患者（n = 91）计划接受腿部骨科手术，所有病例均使用止血带。接受甲哌卡因的患者仅接受日间手术，而接受布比卡因的患者则住院治疗。在侧卧位L3 - 4水平用Tuohy针进行硬膜外穿刺。评估感觉和运动阻滞水平；记录手术期间的不良反应和疼痛情况。患者分为四组：1）26例接受2%甲哌卡因加安慰剂；2）26例接受2%甲哌卡因加0.1mg芬太尼；3）19例接受0.5%布比卡因加安慰剂；4）20例患者接受0.5%布比卡因加0.1mg芬太尼。所有组的感觉阻滞水平相当。甲哌卡因组的运动阻滞程度更强，但甲哌卡因引起的阻滞持续时间较短。添加芬太尼并未改变感觉和运动阻滞情况。术中疼痛报告如下：甲哌卡因/安慰剂组有7例患者；甲哌卡因/芬太尼组有4例患者；布比卡因/安慰剂组有4例患者；布比卡因/芬太尼组有1例患者。这些结果表明，芬太尼与甲哌卡因或布比卡因联合使用时可提高硬膜外阻滞的质量。
