Bartholdy J, Sperling K, Ibsen M, Eliasen K, Mogensen T
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Denmark.
Acta Anaesthesiol Scand. 1994 Apr;38(3):262-5. doi: 10.1111/j.1399-6576.1994.tb03886.x.
In a randomized, blinded trial we assessed the value of adding preoperative infiltration of the surgical area with bupivacaine to a low dose epidural regimen for postoperative pain treatment. Forty-nine patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anaesthesia were studied. Postoperative analgesia was epidural bupivacaine 10 mg/hr-1 + morphine 0.2 mg/hr-1 for 72 h. The patients randomly received preoperative infiltration of the surgical area with bupivacaine 0.25%, 40 ml (group I); or no infiltration (group II). Pain was evaluated at rest, during cough and during mobilization six and eight h after start of surgery, and at 8 a.m. and 4 p.m. on the following days until 72 h after start of surgery. The sensory level of analgesia was evaluated by pin prick. We found no difference between the two groups during rest and cough. However, during mobilization group I had lower pain scores compared to group II (P < 0.05). There was a significant reduction in the need for supplemental intramuscular morphine in the treatment group compared to the control group (P < 0.05). Thus an enhanced analgesic effect was demonstrated by adding preoperative infiltration of the surgical area with local anaesthetic to a low dose epidural bupivacaine/morphine regimen after upper abdominal surgery.
在一项随机、双盲试验中，我们评估了在低剂量硬膜外镇痛方案中加入布比卡因对手术区域进行术前浸润用于术后疼痛治疗的价值。对49例计划在胸段硬膜外联合（布比卡因+吗啡）和全身麻醉下进行上腹部大手术的患者进行了研究。术后镇痛采用硬膜外给予布比卡因10 mg/hr-1+吗啡0.2 mg/hr-1，持续72小时。患者被随机分为两组，一组（I组）接受0.25%布比卡因40 ml对手术区域进行术前浸润；另一组（II组）不进行浸润。在手术开始后6小时和8小时、以及术后次日上午8点和下午4点直至手术开始后72小时，分别于静息时、咳嗽时和活动时评估疼痛情况。通过针刺评估镇痛的感觉平面。我们发现两组在静息和咳嗽时无差异。然而，在活动时，I组的疼痛评分低于II组（P<0.05）。与对照组相比，治疗组补充肌内注射吗啡的需求显著减少（P<0.05）。因此，上腹部手术后在低剂量硬膜外布比卡因/吗啡方案中加入局部麻醉药对手术区域进行术前浸润可增强镇痛效果。
