Rapp S E, Ready L B, Greer B E
Department of Anesthesiology, University of Washington, Seattle 98195.
Gynecol Oncol. 1989 Dec;35(3):341-4. doi: 10.1016/0090-8258(89)90075-9.
Intraoperative analgesia is the purview of anesthesiologists whereas postoperative pain is traditionally managed by surgeons. This series reports 19 months experience of anesthesiologists using epidural opiate analgesia (EOA) or patient-controlled analgesia (PCA) to treat postoperative pain in 302 patients following surgery for pelvic malignancy. For the 244 (81%) patients who received EOA, a lumbar epidural catheter was placed just prior to surgery, injected with local anesthetic for intraoperative analgesia, and injected with preservative-free morphine at appropriate intervals postoperatively to relieve pain. Fifty-eight patients (19%) used PCA which consisted of small self-administered boluses of intravenous narcotics. All patients were seen daily to ensure adequate analgesia and to treat side effects. Utilizing a 0-10 verbal rating scale (0 = no pain; 10 = worst pain imaginable), mean pain with EOA was 0.75 at rest and 2.6 with coughing. Mean pain ratings with PCA were 2.8 at rest and 5.0 during coughing. Side effects with EOA included nausea or vomiting (28%) and pruritus (20%). The only side effect of significance with PCA was nausea or vomiting (21%). All patients improved with treatment of side effects. Acceptance of these techniques is indicated by a steady increase in the number of gynecologic oncology surgical patients utilizing these modalities (50% at the outset to 87% currently).
术中镇痛属于麻醉医生的职责范围，而术后疼痛传统上由外科医生处理。本系列报告了麻醉医生使用硬膜外阿片类镇痛（EOA）或患者自控镇痛（PCA）治疗302例盆腔恶性肿瘤手术后患者术后疼痛的19个月经验。对于244例（81%）接受EOA的患者，在手术前放置腰椎硬膜外导管，注入局部麻醉剂用于术中镇痛，并在术后适当间隔注入无防腐剂吗啡以缓解疼痛。58例患者（19%）使用PCA，其由患者自行注射的小剂量静脉麻醉剂组成。每天对所有患者进行检查，以确保镇痛充分并处理副作用。使用0至10的语言评分量表（0 = 无疼痛；10 = 可想象的最剧烈疼痛），EOA组患者静息时平均疼痛评分为0.75，咳嗽时为2.6。PCA组静息时平均疼痛评分为2.8，咳嗽时为5.0。EOA的副作用包括恶心或呕吐（28%）和瘙痒（20%）。PCA唯一显著的副作用是恶心或呕吐（21%）。所有患者经副作用治疗后均有改善。妇科肿瘤手术患者使用这些方法的人数稳步增加（从一开始的50%增至目前的87%），表明了这些技术的可接受性。
