Burgess F W, Anderson D M, Colonna D, Cavanaugh D G
Anesthesia Pain Management Service, Madigan Army Medical Center, Tacoma, WA.
J Cardiothorac Vasc Anesth. 1994 Aug;8(4):420-4. doi: 10.1016/1053-0770(94)90281-x.
This study was designed to evaluate the potential fentanyl-sparing effect of a dilute local anesthetic, bupivacaine, administered in fixed combinations with fentanyl for post-thoracotomy analgesia via a continuous thoracic epidural infusion. Forty adult patients scheduled for thoracotomy were randomly allocated in a double-blind fashion to receive an epidural infusion containing 0, 0.03, 0.06, or 0.125% bupivacaine in combination with fentanyl (4 micrograms/mL). The epidural infusions were initiated in the operating room at 10 mL/hr. During the first 24 hours, there were no between-group differences in pain scores. Total fentanyl use was significantly decreased 24% to 33% in all bupivacaine treatment groups. However, fentanyl plasma levels at 24 hours were not significantly different between groups. Arterial blood gas measurements performed on the morning after surgery revealed significant reductions in PaCO2 values, 38 +/- 4, 36 +/- 4, 37 +/- 4 mmHg for 0.03, 0.06, and 0.125% bupivacaine groups respectively, versus 44 +/- 6 for the plain fentanyl group. Arterial pH values were significantly higher in all bupivacaine treatment groups. These findings suggest that the combination of dilute bupivacaine with fentanyl for thoracic epidural analgesia for post-thoracotomy pain may have beneficial effects on pulmonary gas exchange.
本研究旨在评估一种稀释的局部麻醉药布比卡因与芬太尼固定组合经连续胸椎硬膜外输注用于开胸术后镇痛时的潜在节省芬太尼效应。40例计划行开胸手术的成年患者被随机双盲分配，接受含0、0.03、0.06或0.125%布比卡因与芬太尼（4微克/毫升）的硬膜外输注。硬膜外输注在手术室以10毫升/小时的速度开始。在最初24小时内，各治疗组间疼痛评分无差异。所有布比卡因治疗组的芬太尼总用量显著减少24%至33%。然而，24小时时各治疗组间芬太尼血浆水平无显著差异。术后次日早晨进行的动脉血气测量显示，0.03%、0.06%和0.125%布比卡因组的PaCO2值显著降低，分别为38±4、36±4、37±4毫米汞柱，而单纯芬太尼组为44±6。所有布比卡因治疗组的动脉pH值显著更高。这些发现表明，稀释的布比卡因与芬太尼联合用于开胸术后疼痛的胸椎硬膜外镇痛可能对肺气体交换有有益作用。
