Türkoğlu Zeynep, Karacaer Feride, Biricik Ebru, Ilgınel Murat, Ünlügenç Hakkı
Erdemli Public Hospital, Mersin, Turkey.
Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey.
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):287-294. doi: 10.5152/TJAR.2019.00936. Epub 2019 Feb 21.
The study was designed to compare the postoperative analgesic efficacy of epidural tramadol or epidural morphine as adjuvant to levobupivacaine in major abdominal surgery.
Patients in ASA I-II group aged between 18 and 65 years were included in study. Epidural catheter was introduced. Patients were randomised into three groups to receive levobupivacaine (Group L), levobupivacaine+morphine (Group LM) and levobupivacaine+tramadol (Group LT). General anaesthesia was administered to all patients. The solution intended for Group L contained 25 mg 0.5% levobupivacaine+15 mL saline, that for Group LM contained 25 mg 0.5% levobupivacaine+14.5 mL salin+100 μg morphine and that for Group LT contained 25 mg 0.5% levobupivacaine+13 mL salin+100 mg tramadol, which was administered via epidural catheter as loading dose 30 min before the end of the operation. Patient-controlled analgesia device was connected to the epidural catheter to provide postoperative analgesia. Bolus dose was adjusted to 12 mg levobupivacaine in Group L, 12 mg levobupivacaine +1.2 mg morphine in Group LM and 12 mg levobupivacaine+12 mg tramadol in Group LT. Lock-out period was adjusted to 15 min in three groups. Quality of analgesia was evaluated using Visual Analogue Scale; administered and demand doses of levobupivacaine, morphine and tramadol were compared at 30 min, 1, 2, 6, 12 and 24 h postoperatively.
Visual Analogue Scale scores were significantly higher in Group L than Groups LM and LT. Nausea and vomiting observed in Group L were lesser than those in Groups LM and LT.
Continuous epidural analgesia using levobupivacaine combined with morphine or tramadol is an effective method for managing postoperative analgesia in major abdominal surgery.
本研究旨在比较硬膜外注射曲马多或吗啡作为左旋布比卡因辅助用药在腹部大手术中的术后镇痛效果。
纳入年龄在18至65岁之间的ASA I-II级患者。置入硬膜外导管。患者被随机分为三组，分别接受左旋布比卡因（L组）、左旋布比卡因+吗啡（LM组）和左旋布比卡因+曲马多（LT组）。所有患者均接受全身麻醉。L组溶液含25mg 0.5%左旋布比卡因+15ml生理盐水，LM组溶液含25mg 0.5%左旋布比卡因+14.5ml生理盐水+100μg吗啡，LT组溶液含25mg 0.5%左旋布比卡因+13ml生理盐水+100mg曲马多，于手术结束前30分钟经硬膜外导管作为负荷剂量给药。将患者自控镇痛装置连接至硬膜外导管以提供术后镇痛。L组的推注剂量调整为12mg左旋布比卡因，LM组为12mg左旋布比卡因+1.2mg吗啡，LT组为12mg左旋布比卡因+12mg曲马多。三组的锁定时间均调整为15分钟。采用视觉模拟评分法评估镇痛质量；比较术后30分钟、1、2、6、12和24小时左旋布比卡因、吗啡和曲马多的给药剂量及需求剂量。
L组的视觉模拟评分显著高于LM组和LT组。L组观察到的恶心和呕吐少于LM组和LT组。
左旋布比卡因联合吗啡或曲马多进行持续硬膜外镇痛是腹部大手术术后镇痛的有效方法。
