Department of Anesthesiology, Tokushima University, Kuramoto, Tokushima, Japan.
Biomed Res Int. 2018 May 15;2018:6297247. doi: 10.1155/2018/6297247. eCollection 2018.
It is well known that the programmed intermittent epidural bolus (PIEB) technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI) in patients undergoing gynecological surgery under combined general-epidural anesthesia.
Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4 mL ropivacaine 0.2% plus fentanyl 2 g/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4 mL/h. In both groups, additional 4 mL boluses of ropivacaine 0.2% plus fentanyl 2 g/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale) 3, 24, and 48 hours after surgery.
In total, 57 patients were randomized ( = 28 and 29 in the PIEB and CEI groups, resp.). The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation): 155.38 (4.55) versus 159.73 (7.87) mL, = 0.016). Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower-upper quartiles]: 0 [0-0.5] versus 3 [0-5.5], = 0.002), 24 hours (1 [0-2] versus 3 [1-4], = 0.003), and 48 hours (1 [0-2] versus 2 [2-3.5], = 0.002) after surgery.
PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.
众所周知，程控间歇硬膜外推注（PIEB）技术可有效提供分娩时的硬膜外麻醉。本随机双盲试验比较了 PIEB 与连续硬膜外输注（CEI）在全身-硬膜外麻醉下接受妇科手术的患者中的术后镇痛效果。
接受全身-硬膜外麻醉下的开放式妇科手术的患者按 1:1 的比例随机分为 PIEB 或 CEI 组。在 PIEB 组中，泵每小时输送 4ml 0.2%罗哌卡因加 2μg/ml 芬太尼。在 CEI 组中，泵以 4ml/h 的速度输送相同的溶液。在两组中，在手术后，当需要时，通过患者自控硬膜外镇痛给予 4ml 0.2%罗哌卡因加 2μg/ml 芬太尼的额外推注。主要结局是手术后 40 小时的总罗哌卡因剂量。次要结局是手术后 3、24 和 48 小时的 PCEA 推注次数和术后疼痛（用 11 点数字评分量表评估）。
共有 57 名患者被随机分配（PIEB 组和 CEI 组各 28 例和 29 例）。两组术后 40 小时的总罗哌卡因剂量差异有统计学意义（平均值（标准差）：155.38（4.55）比 159.73（7.87）ml， = 0.016）。与 CEI 组相比，PIEB 组术后 3 小时（中位数[下四分位数-上四分位数]：0[0-0.5]比 3[0-5.5]， = 0.002）、24 小时（1[0-2]比 3[1-4]， = 0.003）和 48 小时（1[0-2]比 2[2-3.5]， = 0.002）的数字评分量表评分明显较低。
在全身-硬膜外麻醉下接受开放式妇科手术后，PIEB 在提供术后镇痛方面优于 CEI。
