Swenson J D, Hullander R M, Bready R J, Leivers D
Department of Anesthesiology, Naval Medical Center, San Diego, California 92134-5000.
Anesth Analg. 1994 Feb;78(2):215-8. doi: 10.1213/00000539-199402000-00004.
To compare the efficacy of patient-controlled lumbar and thoracic epidural sufentanil, 22 patients scheduled for elective thoracotomy were assigned randomly to receive sufentanil via either a lumbar or a thoracic epidural catheter. For 24 h postoperatively, the patients received analgesia only by patient-controlled epidural sufentanil. There were no significant differences in the visual analog scale (VAS) for pain between the two groups at 8 and 24 h postoperatively. Nausea and pruritus were minimum, requiring treatment less than once per 24-h period in either group. The forced vital capacity (FVC) measured at 24 h (as a percentage of baseline FVC) showed no significant difference between the lumbar and thoracic groups (44.7 +/- 3.8 and 41.7 +/- 5.5; P = 0.68). The total sufentanil used by the lumbar and thoracic groups was not significantly different (196 +/- 25.2 micrograms and 157 +/- 28.6 micrograms; P = 0.32). We conclude that there is no clinical advantage of thoracic over lumbar epidural sufentanil in the thoracotomy patient with respect to quality of analgesia, amount of sufentanil used, severity of side effects, or postoperative pulmonary function.
为比较患者自控腰椎和胸椎硬膜外给予舒芬太尼的疗效，将22例择期开胸手术患者随机分为两组，分别通过腰椎或胸椎硬膜外导管给予舒芬太尼。术后24小时内，患者仅通过患者自控硬膜外给予舒芬太尼进行镇痛。术后8小时和24小时时，两组间疼痛视觉模拟量表（VAS）评分无显著差异。恶心和瘙痒症状轻微，两组中每组每24小时需要治疗的次数均少于1次。术后24小时测量的用力肺活量（FVC，以基础FVC的百分比表示）在腰椎组和胸椎组之间无显著差异（分别为44.7±3.8和41.7±5.5；P = 0.68）。腰椎组和胸椎组使用的舒芬太尼总量无显著差异（分别为196±25.2微克和157±28.6微克；P = 0.32）。我们得出结论，对于开胸手术患者，在镇痛质量、舒芬太尼用量、副作用严重程度或术后肺功能方面，胸椎硬膜外给予舒芬太尼相对于腰椎硬膜外给予舒芬太尼并无临床优势。
