Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Victoria, Australia.
Anaesthesia. 2010 Jul;65(7):721-8. doi: 10.1111/j.1365-2044.2010.06384.x. Epub 2010 Jun 2.
We performed a prospective randomised trial to evaluate the analgesic efficacy of interpleural analgesia in patients undergoing hepatic resection. The control group (n = 25) received multimodal analgesia with intravenous morphine patient-controlled analgesia; in addition, the interventional group (n = 25) received interpleural analgesia with a 20-ml loading dose of levo bupivacaine 0.5% followed by a continuous infusion of levobupivacaine 0.125%. Outcome measures included pain intensity on movement using a visual analogue scale over 24 h, cumulative morphine and rescue analgesia requirements, patient satisfaction, hospital stay and all adverse events. Patients in the interpleural group were less sedated and none required treatment for respiratory depression compared to 6 (24%) in the control group (p< 0.01). Patients in the interpleural group also had lower pain scores during movement in the first 24 h. Patients' satisfaction, opioid requirements and duration of hospital stay were similar. We conclude that continuous interpleural analgesia augments intravenous morphine analgesia, decreases postoperative sedation and reduces respiratory depression after hepatic resection.
我们进行了一项前瞻性随机试验，以评估肋间镇痛在肝切除患者中的镇痛效果。对照组（n=25）接受静脉注射吗啡患者自控镇痛的多模式镇痛；此外，干预组（n=25）接受肋间镇痛，给予 20 毫升左旋布比卡因 0.5%负荷剂量，然后持续输注左旋布比卡因 0.125%。观察指标包括术后 24 小时内运动时的疼痛强度（使用视觉模拟评分）、吗啡累积用量和解救镇痛需求、患者满意度、住院时间和所有不良反应。与对照组（n=25）6 例（24%）相比，肋间组患者镇静程度较低，无一例需要治疗呼吸抑制（p<0.01）。肋间组患者在术后 24 小时内运动时的疼痛评分也较低。患者满意度、阿片类药物需求和住院时间相似。我们的结论是，连续肋间镇痛增强了静脉注射吗啡的镇痛效果，减少了肝切除术后的镇静和呼吸抑制。
