一项随机对照试验，比较在脊髓麻醉下接受下肢骨科手术的患者中，鞘内注射2毫克咪达唑仑与20微克芬太尼作为辅助用药对术后疼痛的影响。
A randomised controlled trial comparing the effect of adjuvant intrathecal 2 mg midazolam to 20 micrograms fentanyl on postoperative pain for patients undergoing lower limb orthopaedic surgery under spinal anaesthesia.
作者信息
Codero Francis, Vitalis Mung'ayi, Thikra Sharif
机构信息
Department of Anaesthesia, Aga Khan University, East Africa.
出版信息
Afr Health Sci. 2016 Mar;16(1):282-91. doi: 10.4314/ahs.v16i1.37.
BACKGROUND
Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post-operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2 mg midazolam with bupivacaine.
OBJECTIVE
To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia.
METHODS
A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups. Group 1: 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2: 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolam.
RESULTS
The duration of effective analgesia was longer in the midazolam group (384.05 minutes) as compared to the fentanyl group (342.6 minutes). There was no significant difference (P 0.4047). The time to onset was significantly longer in midazolam group 17.1 minutes as compared to the fentanyl group 13.2 minutes (P 0.023). The visual analogue score at rescue was significantly lower in the midazolam group (5.55) as compared to the fentanyl group 6.35 (P - 0.043).
CONCLUSION
On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2 mg midazolam as compared to intrathecal 20 micrograms fentanyl for patients undergoing lower limb orthopaedic surgery.
背景
鞘内佐剂被添加到局部麻醉剂中，以提高神经轴阻滞的质量，并延长脊髓麻醉期间的镇痛时间。与单纯布比卡因相比，鞘内使用芬太尼可提高脊髓阻滞的质量，并带来较短的术后镇痛时间。鞘内使用咪达唑仑作为佐剂已被证实可提高脊髓麻醉的质量并延长术后镇痛时间。尚未有研究比较鞘内注射芬太尼与布比卡因以及鞘内注射2mg咪达唑仑与布比卡因的效果。
目的
比较在2.6ml 0.5%重比重布比卡因中添加鞘内注射2mg咪达唑仑与鞘内注射20微克芬太尼对脊髓麻醉下接受下肢骨科手术患者术后疼痛的影响。
方法
总共40例脊髓麻醉下接受下肢骨科手术的患者被随机分为两组。第1组：2.6ml 0.5%重比重布比卡因加0.4ml（20微克）芬太尼；第2组：2.6ml 0.5%重比重布比卡因加0.4ml（2mg）咪达唑仑。
结果
咪达唑仑组的有效镇痛时间（384.05分钟）比芬太尼组（342.6分钟）长。差异无统计学意义（P = 0.4047）。咪达唑仑组的起效时间（17.1分钟）明显长于芬太尼组（13.2分钟）（P = 0.023）。补救时的视觉模拟评分，咪达唑仑组（5.55）明显低于芬太尼组（6.35）（P = 0.043）。
结论
基于本研究结果，对于接受下肢骨科手术的患者，鞘内注射2mg咪达唑仑与鞘内注射20微克芬太尼在有效镇痛时间上无显著差异。
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