Uzuner Ali, Saracoglu Kemal Tolga, Saracoglu Ayten, Erdemli Ozcan
Anesthesiologist, Department of Anesthesiology and Reanimation, Alanya Education and Research Hospital, Antalya, Turkey.
J Res Med Sci. 2011 Sep;16(9):1159-67.
Opioid and local anesthetic infusion by an epidural catheter is widely used as a postoperative pain management method after major abdominal surgeries. There are several agents nowadays to provide sufficient analgesia. The agents which cause less side effects but better quality of analgesia are more valuable. We aimed to postoperatively compare the analgesic, hemodynamic and arrhythmogenic effects of epidural levobupivacaine-fentanyl and bupivacaine-fentanyl solutions.
Fifty patients were scheduled to undergo major abdominal surgery in this clinical trial. The parameters were recorded pre- and post-operatively. In Group I (n=25), bupivacaine with fentanyl solution and in Group II (n=25), levobupivacaine with fentanyl solution was infused via epidural patient-controlled analgesia (PCA). According to the preoperative and postoperative holter recording reports, the arrhythmogenic effects were examined in four catagories: ventricular arrhythmia (VA), supraventricular arrhythmia (SVA), atrioventricular conduction abnormalities and pauses longer than two seconds.
Mean visual analog scale (VAS) values of groups did not differ at all time. They were 6 at the end of the surgery (0. Min, p = 0.622). The scores were 5 in Group I and 4 in Group II in 30. min (p = 0.301). The frequency of SVA was higher in bupivacaine group.
The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.
硬膜外导管输注阿片类药物和局部麻醉药作为腹部大手术后的术后疼痛管理方法被广泛应用。目前有几种药物可提供充分的镇痛效果。副作用较小但镇痛质量更好的药物更具价值。我们旨在术后比较硬膜外左旋布比卡因 - 芬太尼和布比卡因 - 芬太尼溶液的镇痛、血流动力学及致心律失常作用。
本临床试验纳入50例计划行腹部大手术的患者。记录术前和术后参数。在I组（n = 25）中，通过硬膜外患者自控镇痛（PCA）输注布比卡因与芬太尼溶液，II组（n = 25）输注左旋布比卡因与芬太尼溶液。根据术前和术后动态心电图记录报告，从四类情况检查致心律失常作用：室性心律失常（VA）、室上性心律失常（SVA）、房室传导异常以及长于两秒的停搏。
两组的平均视觉模拟评分（VAS）值在所有时间点均无差异。手术结束时为6分（0分钟，p = 0.622）。30分钟时I组评分为5分，II组为4分（p = 0.301）。布比卡因组的SVA发生率更高。
我们的研究结果表明，相同浓度的硬膜外左旋布比卡因和布比卡因与芬太尼可提供稳定的术后镇痛，且对腹部大手术患者均安全。
