Hasenbos M, van Egmond J, Gielen M, Crul J F
Acta Anaesthesiol Scand. 1985 Aug;29(6):577-82. doi: 10.1111/j.1399-6576.1985.tb02257.x.
One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation as well as epidural nicomorphine post-operatively (epidural group). Post-operative nicomorphine in either group was given only at the request of the patient and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group were given nicomorphine exclusively by epidural injection. Patients in the epidural group required significantly less nicomorphine for effective pain relief (29 mg (sd = 10) over a period of 3 days compared to 52 mg (sd = 27) in the intramuscular group. Significantly fewer pulmonary complications in the epidural group were observed (9 atelectases in 83 patients in the epidural group compared to 24 atelectases in 80 patients in the intramuscular group). Only one patient developed pneumonia (intramuscular group). Although the epidural catheter was inserted at the T3-T4 level, no signs of ventilatory depression were found; on the contrary, respiration in the epidural group was significantly better than the intramuscular group. None of the patients, in either analgesia group, needed to be ventilated post-operatively.
163例接受三种不同类型胸科手术的患者被随机分配，要么接受包括静脉注射阿片类药物并术后肌肉注射阿片类药物的平衡静脉麻醉（肌肉注射组），要么接受不使用静脉注射阿片类药物但术中采用高位胸段硬膜外区域阻滞以及术后硬膜外注射尼美吗啡的平衡静脉麻醉（硬膜外组）。两组术后尼美吗啡均仅根据患者需求给予，且根据需要尽可能频繁给药以获得满意的疼痛缓解。硬膜外组患者仅通过硬膜外注射给予尼美吗啡。硬膜外组患者有效缓解疼痛所需的尼美吗啡明显较少（3天内为29mg（标准差=10），而肌肉注射组为52mg（标准差=27））。观察到硬膜外组的肺部并发症明显较少（硬膜外组83例患者中有9例肺不张，而肌肉注射组80例患者中有24例肺不张）。仅1例患者发生肺炎（肌肉注射组）。尽管硬膜外导管在T3 - T4水平插入，但未发现通气抑制迹象；相反，硬膜外组的呼吸明显优于肌肉注射组。两组镇痛组中均无患者术后需要机械通气。
