Nimmo W S, Duthie D J
Anaesth Intensive Care. 1987 Feb;15(1):68-71. doi: 10.1177/0310057X8701500109.
Relief of pain after surgery remains poor for the majority of patients. The pain is unpleasant, and is associated with arterial hypoxaemia, venous thrombosis, myocardial ischaemia and a more florid hormonal response to surgery. Regional analgesia, systemic, subarachnoid or extradural opioids and antiprostaglandin drugs are all used to treat pain after surgery. Systemic opioids are used usually, because regional and axial techniques are labour intensive and antiprostaglandin drugs ineffective. Opioids given orally undergo extensive first pass metabolism and intramuscular doses are absorbed unpredictably. Intravenous administration avoids both problems and excellent results have been obtained using Patient Controlled Analgesia devices, but these machines are expensive. A simple regimen suitable for application to large numbers of surgical patients is required. Continuous infusion of fentanyl 100 micrograms h-1 IV begun two hours before surgery and supplemented by a single bolus dose of fentanyl 100 micrograms IV provided an effective background of analgesia.
对于大多数患者而言，术后疼痛缓解情况仍然欠佳。这种疼痛令人不适，且与动脉血氧不足、静脉血栓形成、心肌缺血以及对手术更为明显的激素反应相关。区域镇痛、全身性、蛛网膜下腔或硬膜外阿片类药物以及抗前列腺素药物均用于治疗术后疼痛。通常使用全身性阿片类药物，因为区域和轴向技术劳动强度大且抗前列腺素药物无效。口服阿片类药物会经历广泛的首过代谢，肌肉注射剂量的吸收也不可预测。静脉给药可避免这两个问题，使用患者自控镇痛装置已取得了良好效果，但这些机器价格昂贵。需要一种适用于大量手术患者的简单方案。术前两小时开始静脉持续输注100微克/小时的芬太尼，并补充单次静脉推注100微克的芬太尼，可提供有效的镇痛背景。
