Stamenkovic D, Geric V, Djordjevic M, Raskovic J, Slavkovic Z, Randjelovic T, Karanikolas M
Department of Anaesthesia, Medical Center "Bezanijska Kosa", Belgrade, Serbia.
Anaesth Intensive Care. 2009 Jul;37(4):552-60. doi: 10.1177/0310057X0903700410.
This study was designed to compare the efficacy of subarachnoid morphine alone or in combination with bupivacaine and fentanyl for combined spinal-epidural analgesia in colorectal surgery. This is a prospective, randomised, double-blind clinical trial. Sixty patients undergoing low anterior resection were assigned to one of three groups: subarachnoid morphine, bupivacaine and fentanyl, subarachnoid morphine and bupivacaine or subarachnoid morphine only. Epidural catheter placement and subarachnoid injection were done via a combined spinal-epidural Epistar needle at L2-3. The epidural catheter was used for scheduled intraoperative bupivacaine and intermittent postoperative bupivacaine and morphine administration. Intraoperative epidural bupivacaine, intraoperative intravenous fentanyl use, time to first analgesia request, postoperative visual analogue scale pain scores, tramadol requirements and side-effects were recorded for 72 hours. Postoperative analgesia was comparable in all groups. Intraoperative fentanyl and bupivacaine consumption was lowest in the morphine, bupivacaine and fentanyl group. Time to first analgesia request was longer in the morphine, bupivacaine and fentanyl compared to the morphine group (P = 0.009). Tramadol use was lower in the morphine and bupivacaine group compared to morphine, bupivacaine and fentanyl (P = 0.017) on postoperative day two. There were no significant adverse effects. All patients ambulated the morning after surgery. The addition of bupivacaine and fentanyl to subarachnoid morphine did not confer any advantage on postoperative visual analogue scale scores and tramadol use, but lowered the need for additional intraoperative intravenous fentanyl and epidural bupivacaine and prolonged the time to first analgesia request.
本研究旨在比较蛛网膜下腔注射吗啡单独使用或与布比卡因和芬太尼联合使用在结直肠手术中进行腰麻-硬膜外联合镇痛的效果。这是一项前瞻性、随机、双盲临床试验。60例行低位前切除术的患者被分为三组之一：蛛网膜下腔注射吗啡、布比卡因和芬太尼组，蛛网膜下腔注射吗啡和布比卡因组或仅蛛网膜下腔注射吗啡组。通过L2-3椎间隙的腰麻-硬膜外联合Epistar穿刺针进行硬膜外导管置入和蛛网膜下腔注射。硬膜外导管用于术中定时注射布比卡因以及术后间断注射布比卡因和吗啡。记录术中硬膜外布比卡因用量、术中静脉注射芬太尼用量、首次镇痛需求时间、术后视觉模拟评分法疼痛评分、曲马多用量及72小时内的副作用。所有组术后镇痛效果相当。吗啡、布比卡因和芬太尼组术中芬太尼和布比卡因消耗量最低。与吗啡组相比，吗啡、布比卡因和芬太尼组首次镇痛需求时间更长（P = 0.009）。术后第二天，吗啡和布比卡因组曲马多用量低于吗啡、布比卡因和芬太尼组（P = 0.017）。未出现明显不良反应。所有患者术后次日早晨即可下床活动。蛛网膜下腔注射吗啡时添加布比卡因和芬太尼对术后视觉模拟评分法评分及曲马多用量无任何优势，但可减少术中额外静脉注射芬太尼和硬膜外布比卡因的用量，并延长首次镇痛需求时间。
