Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan.
J Pak Med Assoc. 2023 Aug;73(8):1587-1591. doi: 10.47391/JPMA.6434.
To investigate the association involving site, concentrations and dosing of local anaesthetics used intraoperatively on postoperative pain scores, motor block and need for rescue analgesia.
The observational study was conducted from June 1, 2020, to May 31, 2021, at the Aga Khan University Hospital, Karachi, and comprised patients planned for major abdominal surgeries with epidurals as primary analgesic modality. They were followed prospectively from placement of epidurals to 24h postoperatively. Data was collected from anaesthesia chart and pain management notes. Data was analysed using SPSS 19.
Of the 170 patients, 96(56.4%) were females and 74(43.5%) were males. The overall mean age was 54.1±12.6 years and mean body mass index was 26.7±5.5Kg/m2. More than half of the patients 110(64.7%) had thoracic epidural, while 60(35.3%) had lumber epidural. Requirement of opioid co-analgesia intraoperatively was significantly high with higher compared to lower concentration of local anaesthetics (p=0.004). The difference in frequencies of motor block was significantly associated with catheter length (p=0.006).
Intraoperative management of epidurals is an essential but overlooked component of perioperative pain management. Guidelines should be formulated for intraoperative epidural analgesic regimens to improve postoperative outcomes.
研究术中局部麻醉剂的使用部位、浓度和剂量与术后疼痛评分、运动阻滞和需要解救性镇痛之间的关联。
本观察性研究于 2020 年 6 月 1 日至 2021 年 5 月 31 日在卡拉奇的 Aga Khan 大学医院进行，纳入计划接受硬膜外麻醉作为主要镇痛方式的大型腹部手术患者。从放置硬膜外导管开始，对患者进行前瞻性随访，直至术后 24 小时。数据从麻醉图表和疼痛管理记录中收集。使用 SPSS 19 进行数据分析。
在 170 名患者中，96 名（56.4%）为女性，74 名（43.5%）为男性。总体平均年龄为 54.1±12.6 岁，平均体重指数为 26.7±5.5kg/m2。超过一半的患者 110 名（64.7%）有胸段硬膜外，60 名（35.3%）有腰段硬膜外。术中需要阿片类药物辅助镇痛的患者比例明显较高，与较低浓度的局部麻醉剂相比（p=0.004）。运动阻滞的发生率与导管长度显著相关（p=0.006）。
硬膜外术中管理是围手术期疼痛管理中一个重要但被忽视的环节。应制定术中硬膜外镇痛方案指南，以改善术后结局。
