Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Bucheon, Korea.
Korean J Anesthesiol. 2011 Jan;60(1):41-6. doi: 10.4097/kjae.2011.60.1.41. Epub 2011 Jan 28.
The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated.
Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 µg/ml) or sufentanil (group S1: sufentanil 0.5 µg/ml, group S2: sufentanil 0.75 µg/ml, and group S3: sufentanil 1.0 µg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery.
Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3.
The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 µg/ml). Therefore, 0.5 µg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.
脂溶性阿片类药物如芬太尼、阿芬太尼和舒芬太尼在患者自控硬膜外镇痛（PCEA）中的应用近来有所增加。本研究旨在探讨舒芬太尼在关节置换术中的效果和适宜剂量。
本研究纳入了 80 名拟行关节置换术的患者。71 名患者（ASA 体格状况 I-III 级）被随机分为四组。所有组均通过 PCEA 接受 0.1%罗哌卡因，每组分别接受芬太尼（组 F：芬太尼 4 µg/ml）或舒芬太尼（组 S1：舒芬太尼 0.5 µg/ml、组 S2：舒芬太尼 0.75 µg/ml 和组 S3：舒芬太尼 1.0 µg/ml）。术后采用视觉模拟评分法（VAS，0-10）评估疼痛评分，并在术后 1、6、12、24、48 小时评估低血压、恶心/呕吐、瘙痒和满意度等不良反应。
术后疼痛评分（VAS）逐渐下降，四组术后 1 小时 VAS 评分最高。四组之间的满意度和术后疼痛评分无差异。组 S1 的瘙痒发生率明显低于组 S2 和组 S3。
组 S1（0.1%罗哌卡因加舒芬太尼 0.5 µg/ml）的不良反应发生率明显较低。因此，PCEA 中舒芬太尼 0.5 µg/ml 是关节置换术后控制疼痛的推荐剂量。
