Scheinin B, Rosenberg P H
Acta Anaesthesiol Scand. 1982 Oct;26(5):474-8. doi: 10.1111/j.1399-6576.1982.tb01802.x.
Morphine 2 mg and 4 mg or bupivacaine 50 mg (another 50 mg 4 h later) was administered into the epidural space prior to general anaesthesia of 40 patients undergoing upper abdominal surgery. During anaesthesia, additional analgesics were not given. In the recovery room (4 h) the pain score (0-10) was lowest in the bupivacaine group (mean 2.4) followed by the 4 mg-morphine group (4.1), 2 mg-morphine group (5.3) and control group (5.7). Half of the patients of the bupivacaine group and those of the 4 mg-morphine group needed no analgesics in the recovery room. Later, in the ward (until next morning 7 am), only morphine patients (5/20) managed without postoperative analgesics. The mean number of requests for analgesics during that time was: 4 mg-morphine 1.3, 2 mg-morphine 1.9, bupivacaine 2.7, and control 2.9. Episodes of hypotension and nausea were most frequent in the bupivacaine group. No serious respiratory complications occurred; 4 h after anaesthesia three patients in the 4 mg-morphine group and two in the bupivacaine group had capillary PCO2 values above 6.65 kPa (50 mmHg), the highest being 7.1 kPa. In two additional patients with choledochal drainage (T-tube), the intracholedochal pressure was shown to rise about 2 kPa 915 mmHg) and 2.7 kPa after epidural injection of 2 mg and 4 mg, respectively. A pressure peak was reached within 10 min and at 75 min the pressure was still 0.7-1.3 kPa above the initial level.
在40例接受上腹部手术的患者全身麻醉前，向其硬膜外腔注入2毫克和4毫克吗啡或50毫克布比卡因（4小时后再注入50毫克）。麻醉期间，未给予额外的镇痛药。在恢复室（4小时），布比卡因组的疼痛评分（0 - 10分）最低（平均2.4分），其次是4毫克吗啡组（4.1分）、2毫克吗啡组（5.3分）和对照组（5.7分）。布比卡因组和4毫克吗啡组各有一半的患者在恢复室不需要镇痛药。后来，在病房（直到次日上午7点），只有吗啡组的患者（5/20）未使用术后镇痛药。在此期间，镇痛药的平均需求次数为：4毫克吗啡组1.3次，2毫克吗啡组1.9次，布比卡因组2.7次，对照组2.9次。低血压和恶心发作在布比卡因组最为频繁。未发生严重的呼吸并发症；麻醉后4小时，4毫克吗啡组有3例患者、布比卡因组有2例患者的毛细血管PCO2值高于6.65千帕（50毫米汞柱），最高值为7.1千帕。另外两名有胆总管引流（T管）的患者，硬膜外分别注入2毫克和4毫克药物后，胆总管内压力分别升高约2千帕（15毫米汞柱）和2.7千帕。10分钟内达到压力峰值，75分钟时压力仍比初始水平高0.7 - 1.3千帕。
