Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2010 Feb;25(2):287-92. doi: 10.3346/jkms.2010.25.2.287. Epub 2010 Jan 19.
We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microg fentanyl/epinephrine (n=31) and 2% lidocaine/saline/epinephrine (n=30) when extending an epidural labor analgesia using low-dose ropivacaine and fentanyl. Survival analysis for the sensory blocks to the T4 level showed no statistically significant differences in onset time to T4 between the 2 groups. Onset times (min) to T4-sensory blocks for cold and pinprick were not different between the two groups. However, median maximum sensory level in the lidocaine-fentanyl group (T1 for cold and T2 for pinprick) was significantly higher than that in the lidocaine-saline group (T3 and T4, respectively). The lidocaine-fentanyl group exhibited less visceral pain (6.5% vs. 36.7%), less supplementation of lidocaine (6.5% vs. 43.3%), and less nausea (6.5% vs. 26.7%) compared with the lidocaine-saline group during the intraoperative period. It is concluded that adding fentanyl to 2% lidocaine does not speed up the onset of the block when the onset is tested with cold or sharp pinprick but improves the quality of analgesia with fewer side effects in emergency top-up for cesarean section.
我们进行了一项前瞻性、随机、双盲研究，比较了在使用低剂量罗哌卡因和芬太尼延长硬膜外分娩镇痛时，使用 2%利多卡因/100 微克芬太尼/肾上腺素（n=31）和 2%利多卡因/生理盐水/肾上腺素（n=30）进行局部追加时的局部追加效果。T4 水平感觉阻滞的生存分析显示，两组 T4 感觉阻滞的起始时间无统计学差异。两组间冷觉和刺痛觉 T4 感觉阻滞的起始时间（min）无差异。然而，利多卡因-芬太尼组的中位最大感觉阻滞平面（冷觉为 T1，刺痛觉为 T2）显著高于利多卡因-生理盐水组（分别为 T3 和 T4）。与利多卡因-生理盐水组相比，利多卡因-芬太尼组在术中期间内脏痛（6.5% vs. 36.7%）、利多卡因补充（6.5% vs. 43.3%）和恶心（6.5% vs. 26.7%）更少。结论：在使用冷或锐刺痛觉进行测试时，向 2%利多卡因中加入芬太尼不会加速阻滞的起始，但在剖宫产紧急局部追加时，可改善镇痛质量，且副作用更少。
