Hayashi H, Nishiuchi T, Tamura H, Takeda K
Department of Anesthesia, Osaka National Hospital.
Masui. 1993 Dec;42(12):1763-8.
This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.
本研究通过持续硬膜外输注，探讨丁丙诺啡和芬太尼对术后疼痛缓解的镇痛效果及不良反应。50例上腹部或下腹部手术后患者被分为两组，术后硬膜外给予丁丙诺啡和芬太尼。丁丙诺啡（B）组静脉推注0.1mg丁丙诺啡+8ml生理盐水，持续输注0.8mg丁丙诺啡+92ml生理盐水（2ml·h-1）。芬太尼组静脉推注0.1mg芬太尼+6ml生理盐水，持续输注0.6mg芬太尼+84ml生理盐水（2ml·h-1）。两组镇痛效果无显著差异，术后2至12小时镇痛效果均降低。然而，与丁丙诺啡组相比，芬太尼组恶心或呕吐及头晕的发生率显著更低（分别为11例对4例和7例对1例）。这些结果表明，硬膜外给予芬太尼的主要作用部位是脊髓。相反，硬膜外丁丙诺啡的镇痛作用似乎因脊髓上作用而增强。我们得出结论，持续硬膜外输注时，芬太尼在术后疼痛缓解方面优于丁丙诺啡。
