Mihic D N, Abram S E
Department of Anaesthesia, Privatklinik Linde, Switzerland.
Eur J Anaesthesiol. 1993 Jul;10(4):297-301.
Regional anaesthesia for abdominal hysterectomy is commonly combined with heavy sedation or light general anaesthesia in order to avoid the occurrence of visceral pain. Our clinical experience has indicated that this pain can be controlled using regional anaesthesia techniques alone. In an effort to find the optimal technique, we randomly assigned 200 ASA and I and II patients who requested regional anaesthesia for abdominal hysterectomy (with or without elective appendicectomy) to one of five groups: 1) subarachnoid bupivacaine; 2) subarachnoid bupivacaine plus intravenous midazolam and buprenorphine; 3) epidural bipivacaine; 4) epidural bupivacaine plus epidural morphine; 5) subarachnoid bupivacaine plus epidural morphine and bupivacaine. The last combination provided by far the best analgesia. Only two of 40 patients complained of slight discomfort, and this was easily controlled. Success rates correlated also with the height of the blockade. It was concluded that the combination of subarachnoid bupivacaine plus epidural morphine and bupivacaine represents an effective and reliable technique for abdominal hysterectomy with or without elective appendicectomy.
腹式子宫切除术的区域麻醉通常与深度镇静或浅全身麻醉联合使用，以避免内脏痛的发生。我们的临床经验表明，仅使用区域麻醉技术即可控制这种疼痛。为了找到最佳技术，我们将200例因腹式子宫切除术（有或无择期阑尾切除术）而要求进行区域麻醉的ASA I级和II级患者随机分为五组之一：1）蛛网膜下腔布比卡因；2）蛛网膜下腔布比卡因加静脉注射咪达唑仑和丁丙诺啡；3）硬膜外布比卡因；4）硬膜外布比卡因加硬膜外吗啡；5）蛛网膜下腔布比卡因加硬膜外吗啡和布比卡因。最后一种联合用药提供了迄今为止最好的镇痛效果。40例患者中只有2例抱怨有轻微不适，且很容易控制。成功率也与阻滞高度相关。得出的结论是，蛛网膜下腔布比卡因加硬膜外吗啡和布比卡因的联合用药是一种用于有或无择期阑尾切除术的腹式子宫切除术的有效且可靠的技术。
