Liu S, Angel J M, Owens B D, Carpenter R L, Isabel L
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Reg Anesth. 1995 Jul-Aug;20(4):303-10.
Combinations of bupivacaine and fentanyl are popular for postoperative epidural analgesia. However, there are little data from which to select a rational dose of bupivacaine. The study examined the effects of increasing amounts of epidural bupivacaine on postoperative analgesia, epidural fentanyl consumption, and side effects after thoracotomy.
Twenty-four patients were randomized in a double-blind manner to receive intra- and postoperative epidural infusions of either saline, 0.01% bupivacaine, 0.05% bupivacaine, or 0.1% bupivacaine at 10 mL/h. All patients received a standardized combined epidural (120 mg lidocaine and 1.5 micrograms/kg of fentanyl) and general anesthesia. Further postoperative analgesia was provided with fentanyl patient-controlled epidural analgesia (PCEA) only.
There were no differences between groups in visual analog scale (VAS) pain scores at rest or cough, but 10 and 5 mg/h of bupivacaine provided better analgesia during physiotherapy (P < .05). The use of 10 and 5 mg/h of bupivacaine led to significant opioid sparing (50% decrease) when compared to saline and 1 mg/h bupivacaine (P < .03). There was a trend toward a greater incidence of orthostasis with the use of bupivacaine at 10 mg/h (P = .09). Incidences of opioid side effects were not different between groups.
The results demonstrate improved analgesia with physiotherapy and significant opioid sparing when 10 and 5 mg/h doses of bupivacaine are used. However, the incidence of orthostasis may be increased with the use of 10 mg/h. Thus, 5 mg/h of epidural bupivacaine (.05% at 10 mL/h) improved analgesia, decreased opioid requirements, and did not have detectable hemodynamic effects.
布比卡因与芬太尼联合用药常用于术后硬膜外镇痛。然而，可供选择合理布比卡因剂量的数据很少。本研究探讨增加硬膜外布比卡因剂量对开胸术后镇痛、硬膜外芬太尼用量及副作用的影响。
24例患者以双盲方式随机分组，分别接受术中及术后硬膜外输注生理盐水、0.01%布比卡因、0.05%布比卡因或0.1%布比卡因，速度为10 mL/h。所有患者均接受标准化的联合硬膜外麻醉（120 mg利多卡因和1.5微克/千克芬太尼）和全身麻醉。术后仅通过芬太尼患者自控硬膜外镇痛（PCEA）提供进一步镇痛。
各组在静息或咳嗽时的视觉模拟评分（VAS）疼痛评分无差异，但10 mg/h和5 mg/h的布比卡因在物理治疗期间提供了更好的镇痛效果（P < 0.05）。与生理盐水和1 mg/h布比卡因相比，使用10 mg/h和5 mg/h的布比卡因导致显著的阿片类药物节省（减少50%）（P < 0.03）。使用10 mg/h布比卡因时，直立性低血压的发生率有增加趋势（P = 0.09）。各组阿片类药物副作用的发生率无差异。
结果表明，使用10 mg/h和5 mg/h剂量的布比卡因时，物理治疗期间镇痛效果改善，阿片类药物显著节省。然而，使用10 mg/h时直立性低血压的发生率可能会增加。因此，5 mg/h的硬膜外布比卡因（10 mL/h时为0.05%）改善了镇痛效果，减少了阿片类药物的需求，且未产生可检测到的血流动力学影响。
