Department of Anaesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
Pain Med. 2013 Aug;14(8):1248-53. doi: 10.1111/pme.12128. Epub 2013 Apr 24.
Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in clinically relevant post-void residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is not completely elucidated.
Pooled analysis of an open observational study and a double-blind randomized trial.
Single tertiary centre.
Twenty-eight women without lower urinary tract symptoms and post-void residual <100 mL, who underwent open renal surgery with TEA.
Pooling results in three groups with different epidural regimens (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/mL, and 13 with bupivacaine 0.1% plus fentanyl 2 μg/mL and epinephrine 2 μg/mL). All women underwent urethral pressure measurements before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9.
Maximum urethral closure pressure at rest decreased significantly during TEA with bupivacaine alone (median 70 cm H2 O [interquartile range 66-76] to 43 [43-65], P = 0.031) and with bupivacaine/fentanyl/epinephrine (75 cm H2 O [68-78] to 56 [52-75], P = 0.028), whereas with bupivacaine/fentanyl, no significant change could be detected (74 [51-88] vs 67 [46-70], P = 0.156). In all groups, functional profile length at rest was not influenced during TEA.
TEA with bupivacaine and the addition of fentanyl and epinephrine appears to decrease maximum urethral closure pressure at rest in women. The addition of fentanyl alone to bupivacaine may reduce this effect. Thus, the TEA effect on urethral sphincter function seems to depend on the drug mixture administered.
胸椎硬膜外镇痛（TEA）已被证明可抑制接受开放式肾脏手术患者的逼尿肌活动，导致临床上有意义的残余尿量。然而，不同硬膜外药物混合物对尿道括约肌功能的影响尚未完全阐明。
对一项开放性观察性研究和一项双盲随机试验进行汇总分析。
单中心。
28 名无下尿路症状且残余尿量<100ml 的女性，接受开放式肾脏手术并进行 TEA。
将三种不同硬膜外方案的结果汇总到三组中（7 例使用布比卡因 0.125%，8 例使用布比卡因 0.125%和 2μg/ml 芬太尼，13 例使用布比卡因 0.1%加 2μg/ml 芬太尼和 2μg/ml 肾上腺素）。所有女性在 TEA 前和术后 2-3 天 TEA 时进行尿道压力测量。所有患者均在 T8-9 间隙插入点进行 TEA。
单独使用布比卡因（中位 70cmH2O[四分位距 66-76]至 43[43-65]，P=0.031）和布比卡因/芬太尼/肾上腺素（75cmH2O[68-78]至 56[52-75]，P=0.028）时，最大尿道闭合压在 TEA 期间显著降低，而布比卡因/芬太尼时，未检测到显著变化（74[51-88]vs67[46-70]，P=0.156）。在所有组中，休息时的功能谱长度在 TEA 期间不受影响。
布比卡因加芬太尼和肾上腺素似乎会降低女性静息时的最大尿道闭合压，而单独加芬太尼可能会降低这种效应。因此，TEA 对尿道括约肌功能的影响似乎取决于所使用的药物混合物。
