Pigot B, Petit J, Eustache M L, Oksenhendler G, Winckler C
Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital Charles-Nicolle, Rouen.
Ann Fr Anesth Reanim. 1987;6(5):434-8. doi: 10.1016/s0750-7658(87)80370-2.
On demand intravenous naloxone reverses respiratory depression following epidural morphine but does not have any effect on analgesia. This study aimed to assess the action of a preventive naloxone infusion on the side-effects and analgesia induced by epidural fentanyl. Sixteen patients were studied. Three had isolated uncomplicated flail chest. The thirteen others had undergone thoracotomy, and were included in the protocol at least 6 h after extubation. All patients had two epidural injections, they received an intravenous infusion of either 10 micrograms.kg-1.h-1 naloxone after a 400 micrograms bolus (group F + N) or 5% dextrose (group F), which was randomly allocated. In group F, but not in group F + N PaCO2 increased from the 15th min to the 4th, and sedation occurred from the 15th min to the 6th h. A significant and similar pain relief was noted in both groups. Duration of analgesia was not statistically different in the two groups. This preventive action of intravenous naloxone on the supraspinal adverse effects of epidural fentanyl was not accompanied by a reduction in analgesia. This could lead to widespread use of this analgesic technique.
按需静脉注射纳洛酮可逆转硬膜外吗啡所致的呼吸抑制，但对镇痛无任何影响。本研究旨在评估预防性输注纳洛酮对硬膜外芬太尼引起的副作用和镇痛效果的作用。研究了16例患者。3例为单纯性连枷胸，无并发症。另外13例接受了开胸手术，在拔管后至少6小时纳入研究方案。所有患者均接受两次硬膜外注射，随机分为两组，一组在给予400微克负荷剂量后接受10微克·千克⁻¹·小时⁻¹纳洛酮静脉输注（F + N组），另一组接受5%葡萄糖静脉输注（F组）。在F组而非F + N组，从第15分钟到第4小时PaCO₂升高，从第15分钟到第6小时出现镇静。两组均观察到显著且相似的疼痛缓解。两组镇痛持续时间无统计学差异。静脉注射纳洛酮对硬膜外芬太尼的脊髓上不良反应的这种预防作用并未伴随镇痛作用的降低。这可能导致这种镇痛技术的广泛应用。
