Hida Kumiko, Murata Hiroaki, Ichinomiya Taiga, Inoue Haruka, Sato Shuntaro, Hara Tetsuya
Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
Reg Anesth Pain Med. 2019 Mar;44(3):326-332. doi: 10.1136/rapm-2018-100021. Epub 2019 Jan 22.
This randomized, controlled, double-blind trial compared the effectiveness of levobupivacaine delivery of a programmed intermittent paravertebral bolus with a continuous paravertebral infusion.
Thirty-two consecutively enrolled patients who underwent unilateral video-assisted thoracic surgery were randomized to receive either a programmed intermittent paravertebral bolus of 10 mL of 0.2% levobupivacaine every 2 hours (Bolus group, n=16) or a continuous paravertebral infusion of 0.2% levobupivacaine at 5 mL/hour (Infusion group, n=16) after the operation. Postoperatively, after injection of 20 mL of 0.25% levobupivacaine through the paravertebral catheter, a mechanical infusion pump was set depending on the assigned group. The primary efficacy outcome was the number of anesthetized dermatomes 24 hours after the initial bolus of levobupivacaine. The secondary efficacy outcomes included the number of anesthetized dermatomes at other time points, pain at rest and coughing, additional analgesic use and patient acceptance of the analgesic technique. Arterial levobupivacaine concentration was measured to ensure safety. P<0.05 was considered statistically significant.
The mean (95% CI) number of anesthetized dermatomes 24 hours after the initial bolus of levobupivacaine was significantly larger among subjects receiving programmed intermittent bolus (n=16) compared with those receiving continuous infusion (n=16; 6.8 (5.7-7.9) vs 3.1 (2.0-4.2); p<0.001). The arterial levobupivacaine concentration did not reach a toxic level.
The programmed intermittent paravertebral bolus of levobupivacaine provided a wider dermatomal spread of sensory block than continuous paravertebral infusion with an identical hourly dose of levobupivacaine.
UMIN000022532.
本随机、对照、双盲试验比较了左旋布比卡因程序化间歇性椎旁推注与持续椎旁输注的效果。
32例连续入选的接受单侧电视辅助胸腔手术的患者被随机分为两组，术后一组每2小时接受10毫升0.2%左旋布比卡因的程序化间歇性椎旁推注（推注组，n = 16），另一组以5毫升/小时的速度持续椎旁输注0.2%左旋布比卡因（输注组，n = 16）。术后，通过椎旁导管注射20毫升0.25%左旋布比卡因后，根据分组设置机械输注泵。主要疗效指标是首次推注左旋布比卡因后24小时麻醉皮节的数量。次要疗效指标包括其他时间点麻醉皮节的数量、静息和咳嗽时的疼痛、额外镇痛药物的使用以及患者对镇痛技术的接受度。测量动脉左旋布比卡因浓度以确保安全。P<0.05被认为具有统计学意义。
与接受持续输注的患者（n = 16）相比，接受程序化间歇性推注的患者（p<0.001）在首次推注左旋布比卡因后24小时麻醉皮节的平均数量（95%CI）显著更多（n = 16；6.8（5.7 - 7.9）对3.1（2.0 - 4.2））。动脉左旋布比卡因浓度未达到中毒水平。
与相同每小时剂量的左旋布比卡因持续椎旁输注相比，左旋布比卡因程序化间歇性椎旁推注提供了更广泛的感觉阻滞皮节扩散。
UMIN000022532。
