Aguilar J L, Samper D, Montes A, Llorente C, Roca G, Preciado M J
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Barcelona.
Rev Esp Anestesiol Reanim. 1994 Sep-Oct;41(5):278-81.
To compare the intensity of postoperative pain after thoracotomy with 2 anesthetic techniques: 1) thoracic epidural block with bupivacaine administered before surgery (combined anesthesia with isoflurane) and 2) conventional balanced anesthesia with isoflurane and endovenous fentanyl.
Thirty patients scheduled for thoracotomy by lateral incision (T5-T6) were randomly divided into 2 groups of 15. Group A received 8 ml of 0.5% bupivacaine with adrenalin 1:200.000 30 min before start of surgery while group B received 8 ml saline solution through an epidural catheter inserted to T4-T8. Combined anesthesia (4 ml 0.5% bupivacaine through an epidural catheter 150 min after the first dose and isoflurane in 100% oxygen) was used in group A. Group B received balanced anesthesia with endovenous fentanyl 2.5 micrograms/kg and isoflurane in 100% oxygen. The difference in pain intensity during postoperative recovery was assessed by way of the following variables: number of boluses administered by epidural patient-controlled analgesia (bupivacaine 0.0625% and fentanyl 6 micrograms/ml); score on a visual analog scale of 10 at baseline and at 1, 3, 7, 11, 19 and 43 hours after surgery; and need for additional analgesia (diclofenac) during the 43 hours of study. Arterial gases were measured during the preoperative period and at 1, 3, 7, 19 and 43 hours after surgery.
No significant differences in pain intensity measured on the visual analog scale, by the number of boluses per patients or by need for additional analgesia were found between the 2 groups. The total number of boluses administered and additional analgesic requirements were greater in the group receiving bupivacaine, although the difference was not significant (p = 0.095 and p = 0.056, respectively). Nor were there significant differences in pH and PaCO2 levels for the 2 groups.
Analgesic efficacy after thoracotomy was similar for our 2 groups receiving either combined anesthesia (epidural bupivacaine at 0.5% and isoflurane) or balanced anesthesia with isoflurane and endovenous fentanyl.
比较两种麻醉技术用于开胸术后的疼痛强度：1）术前使用布比卡因进行胸段硬膜外阻滞（与异氟烷联合麻醉）和2）使用异氟烷和静脉注射芬太尼的传统平衡麻醉。
30例计划行侧切口开胸术（T5 - T6）的患者随机分为两组，每组15例。A组在手术开始前30分钟接受8毫升含1:200,000肾上腺素的0.5%布比卡因，而B组通过插入T4 - T8的硬膜外导管接受8毫升生理盐水。A组采用联合麻醉（首剂后150分钟通过硬膜外导管给予4毫升0.5%布比卡因并吸入100%氧气中的异氟烷）。B组接受静脉注射2.5微克/千克芬太尼和吸入100%氧气中的异氟烷的平衡麻醉。通过以下变量评估术后恢复期间的疼痛强度差异：硬膜外患者自控镇痛（0.0625%布比卡因和6微克/毫升芬太尼）给药的推注次数；术前及术后1、3、7、11、19和43小时的10分视觉模拟评分；以及研究的43小时内额外镇痛（双氯芬酸）的需求。在术前及术后1、3、7、19和43小时测量动脉血气。
两组之间在视觉模拟评分法测量的疼痛强度、每位患者的推注次数或额外镇痛需求方面未发现显著差异。接受布比卡因的组推注总次数和额外镇痛需求更多，尽管差异不显著（分别为p = 0.095和p = 0.056）。两组的pH值和PaCO2水平也无显著差异。
接受联合麻醉（0.5%硬膜外布比卡因和异氟烷）或异氟烷与静脉注射芬太尼平衡麻醉的两组患者，开胸术后的镇痛效果相似。
