Division of Anesthesiology and Intensive Care, Department of Medicine, Clinical Epidemiology and Biostatistical Unit, Orebro University, Orebro, Sweden.
Br J Anaesth. 2011 Nov;107(5):782-9. doi: 10.1093/bja/aer296. Epub 2011 Sep 23.
Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA).
Fifty patients, ASA I-II, participated in this prospective, double-blinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient-controlled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml⁻¹ via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h⁻¹ of ropivacaine 1 mg ml⁻¹, fentanyl 2 μg ml⁻¹, and epinephrine 2 μg ml⁻¹ epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required.
Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0-10)] compared with Group PCLA [4 (0-10)] (P<0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (P<0.05). Morphine consumption was significantly greater in Group PCLA [12 (0-46)] compared with Group TEA [0 (0-20)] at 0-48 h after operation [median (range)] (P=0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (P<0.01).
TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.
根治性前列腺切除术（radical retropubic prostatectomy）后会出现中到重度疼痛。本研究的主要目的是评估腹腔内局部麻醉药（intra-abdominal local anaesthetics）与胸硬膜外镇痛（thoracic epidural analgesia，TEA）相比是否具有相似的镇痛效果。
50 名 ASA I-II 级的患者参与了这项前瞻性、双盲研究。所有患者均接受 TEA。手术后，他们被随机分为两组，每组 25 名患者：PCLA 组（患者自控局部镇痛）：通过腹腔内导管自行给予 10 ml 2 mg/ml 的罗哌卡因，持续 48 小时。TEA 组：硬膜外输注 10 ml/h 浓度为 1 mg/ml 的罗哌卡因、2 μg/ml 的芬太尼和 2 μg/ml 的肾上腺素，持续 48 小时。主要终点是术后 4 小时咳嗽时的疼痛程度。需要时静脉给予吗啡作为解救药物。
TEA 组咳嗽时的疼痛程度在术后 4、24 和 48 小时显著低于 PCLA 组[0（0-10）比 4（0-10）]（P<0.05）。与 PCLA 组相比，TEA 组在切口部位、深部疼痛和术后 4 和 24 小时咳嗽时的疼痛强度也显著较低（P<0.05）。术后 0-48 小时，PCLA 组吗啡用量[12（0-46）]显著大于 TEA 组[0（0-20）]（P=0.015）。与 PCLA 组相比，TEA 组在术后 24 小时的最大呼气压力更高（P<0.01）。
与 PCLA 相比，TEA 可提供更优的术后镇痛效果，并更好地保留呼气肌力量。
