Hjortsø N C, Neumann P, Frøsig F, Andersen T, Lindhard A, Rogon E, Kehlet H
Acta Anaesthesiol Scand. 1985 Nov;29(8):790-6. doi: 10.1111/j.1399-6576.1985.tb02302.x.
A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. The incidence of deep venous thrombosis (125I-fibrinogen scan) was 32% after general anaesthesia and low-dose heparin and 34% after epidural analgesia with no prophylactic antithrombotic treatment (P greater than 0.9). Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
一百例计划接受择期腹部手术的患者被随机分为两组，一组接受全身麻醉（低剂量芬太尼）并在术后使用吗啡进行全身镇痛，另一组在术中采用全身麻醉与硬膜外镇痛联合的方式（T4-S5节段，使用1.5%依替卡因），术后24小时使用0.5%布比卡因5ml/4小时，并在72小时内每12小时使用4mg吗啡。硬膜外镇痛方案能更好地控制术后疼痛（P小于0.0001）。我们发现，硬膜外镇痛方案并未显著降低术后死亡率（从6%降至2%）、肺炎发生率（从28%降至20%）、心律失常发生率（从10%降至5%）以及伤口并发症发生率（从14%降至11%）。在未进行预防性抗血栓治疗的情况下，全身麻醉联合低剂量肝素组的深静脉血栓形成发生率（125I-纤维蛋白原扫描）为32%，硬膜外镇痛组为34%（P大于0.9）。两组患者术后体重减轻、血清白蛋白和血清转铁蛋白降低情况，以及血红蛋白降低程度和术后输血需求均相似。通过术后疲劳程度、肠道功能恢复情况（排气、排便和食物摄入）以及患者恢复到术前自理水平所需时间来评估的康复情况，硬膜外镇痛并未使其缩短。由于每组中有50%的患者出现了上述一种或多种术后并发症，因此尽管硬膜外镇痛方案实现了充分的疼痛缓解，但在降低大型腹部手术后的术后发病率方面并无效果。
