Poirier T, Laaban J P, Guyon F, Vuong T K, Dermine H, Rochemaure J
Service de Pneumologie et de Réanimation, Hôtel-Dieu, Paris.
Rev Mal Respir. 1990;7(2):141-6.
The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.
本研究旨在评估硬膜外胸椎镇痛（ATP）对预防四环素胸膜粘连术（STP）治疗气胸（PNO）过程中出现的疼痛的价值。12例（年龄27±6岁）自发性气胸患者在ATP（于D5 - D6水平）联合芬太尼（0.1mg）和0.5%布比卡因肾上腺素（1mg/kg）覆盖下接受了13次STP（1g四环素稀释于60ml生理盐水中）。该方案连续使用三天。9例患者在第一天进行了多次血布比卡因水平测定。没有患者出现需要注射胃肠外吗啡和/或中断该方案的难以忍受的疼痛。对于两名患者（其中一名先进行右侧粘连术，一个月后进行左侧粘连术），实现粘连的治疗过程完全无痛。10例患者经历了中度疼痛，主要在第一天，通过再次硬膜外注射布比卡因（25mg）（n = 9）或胃肠外注射非吗啡类镇痛药（n = 1）得以缓解。没有患者出现呼吸抑制、虚脱或心动过缓。血布比卡因水平始终显著低于中毒水平（1.6mg）。观察到的结果表明，ATP（芬太尼和布比卡因）是一种有效、无毒且耐受性良好的方法，可预防STP治疗PNO时出现的难以忍受的疼痛。
