Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
J Clin Anesth. 2010 Sep;22(6):410-4. doi: 10.1016/j.jclinane.2009.10.011.
To evaluate the efficacy of thoracic epidural analgesia (TEA) in scoliosis surgery.
Descriptive clinical study.
University hospital.
15 ASA physical status I, II, and III patients undergoing thoracolumbar scoliosis correction.
TEA was performed at three to 5 cm cephalad to the incision, and 5 to 10 mL of 0.125% - 0.2% levobupivacaine was given initially. Then, 5 to 10 mL of levobupivacaine was infused hourly throughout the operation. General anesthesia (GA) was induced with thiopental sodium (5 mg/kg) and fentanyl (one μg/kg) and was maintained with 0.2% sevoflurane and 50% nitrous oxide in oxygen. Intraoperative epidural morphine (two to three mg) was administered, and 0.1% levobupivacaine with morphine (0.04 to 0.08 mg/mL) was infused at two to 4 mL/hr for postoperative analgesia.
Adequacy of anesthesia, postanesthetic recovery and analgesia, adverse effects, and patient satisfaction were recorded.
20% of patients underwent more than 10 levels of correction, and 53% had coexisting morbid diseases. All had adequate anesthesia. Immediately in the Postanesthesia Care Unit (PACU), 67% of patients reached an Aldrete score of 10, and 40% were fully awake and oriented. All patients were arousable to command and able to flex their hips and knees. None had intraoperative recall. 73% reported no pain in the PACU or 6 hours postoperatively. No serious adverse effects occurred. 80% of patients rated their satisfaction as "good".
Preincisional application of TEA with light GA may be used effectively in thoracolumbar scoliosis surgery.
评估胸椎硬膜外镇痛（TEA）在脊柱侧凸手术中的疗效。
描述性临床研究。
大学医院。
15 名 ASA 身体状况 I、II 和 III 级患者，行胸腰椎脊柱侧凸矫正术。
TEA 在切口上方 3 至 5 厘米处进行，最初给予 0.125%-0.2%布比卡因 5 至 10 毫升。然后，在整个手术过程中每小时输注 5 至 10 毫升布比卡因。全身麻醉（GA）采用硫喷妥钠（5mg/kg）和芬太尼（1μg/kg）诱导，并以 0.2%七氟醚和 50%氧化亚氮混合氧气维持。术中给予硬膜外吗啡（2 至 3mg），术后镇痛给予 0.1%布比卡因加吗啡（0.04 至 0.08mg/mL），以 2 至 4mL/hr 输注。
记录麻醉效果、麻醉后恢复和镇痛、不良反应和患者满意度。
20%的患者行超过 10 个节段的矫正，53%合并有并存疾病。所有患者均有足够的麻醉。在麻醉后恢复室（PACU）立即，67%的患者达到 Aldrete 评分 10 分，40%的患者完全清醒并定向。所有患者均能听从命令唤醒，能屈伸髋膝关节。无术中回忆。73%的患者在 PACU 或术后 6 小时无疼痛。无严重不良反应发生。80%的患者对满意度评价为“好”。
在胸腰椎脊柱侧凸手术中，预防性应用 TEA 联合轻度 GA 可能有效。
