Kolvenbach H, Lauven P M, Schneider B, Kunath U
Department of Surgery, University of Bonn, FRG.
Thorac Cardiovasc Surg. 1989 Oct;37(5):273-6. doi: 10.1055/s-2007-1020331.
After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). We compared their personal and perioperative data with those of another 30 patients, receiving opiates systemically after major thoracic surgery (SA-group). Multiple blood samples from the ICB-group were analyzed by gaschromatography for bupivacaine concentration-time-profiles. In 19 of 25 patients (76%) the bupivacaine-injections provided sufficient analgesia, 6 patients required additional analgesics. The duration of general anaesthesia (ICB: 174 min vs. SA: 136 min) and the operation time (ICB: 103 min vs. SA: 94 min) were not statistically different in both groups. The periods of intensive care therapy (ICB: 0.7 d vs. SA: 1.2 d), artificial respiration (ICB: 11.2 h vs. SA: 21.6 h) and hospital stay (ICB: 12.1 d vs. SA: 14.2 d) were shorter for the ICB-group. Atelectasis (ICB: 20% vs. SA: 37%) and pneumonia (ICB: 0 vs. SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)
在进行前外侧开胸手术后，在关闭切口前，在手指和/或视觉引导下经皮将留置塑料导管插入手术入路肋间间隙及其相邻的两个肋间间隙。最初，我们通过每个导管注射25毫克布比卡因（总量为75毫克），随后根据患者需求，每个导管再注射15至25毫克。迄今为止，25例患者通过这种方法接受了重复肋间神经阻滞（肋间神经阻滞组）。我们将他们的个人和围手术期数据与另外30例在胸科大手术后全身使用阿片类药物的患者（全身用药组）的数据进行了比较。对肋间神经阻滞组的多份血样进行气相色谱分析，以获取布比卡因浓度-时间曲线。25例患者中有19例（76%）布比卡因注射提供了充分的镇痛效果，6例患者需要额外的镇痛药。两组的全身麻醉时间（肋间神经阻滞组：174分钟 vs. 全身用药组：136分钟）和手术时间（肋间神经阻滞组：103分钟 vs. 全身用药组：94分钟）无统计学差异。肋间神经阻滞组的重症监护治疗时间（0.7天 vs. 全身用药组：1.2天）、人工呼吸时间（11.2小时 vs. 全身用药组：21.6小时）和住院时间（12.1天 vs. 全身用药组：14.2天）较短。与对照组相比，肺不张（肋间神经阻滞组：20% vs. 全身用药组：37%）和肺炎（肋间神经阻滞组：0 vs. 全身用药组：13%）的发生率较低，而25例肋间神经阻滞组患者中有6例发生快速心律失常，30例全身用药组患者中有4例发生。然而，这些参数均未达到统计学显著性（p小于0.05）。肋间应用布比卡因29±12分钟后，布比卡因最高水平为0.65±0.21微克/毫升。（摘要截短至250字）
