Savader S J, Bourke D L, Venbrux A C, Trerotola S O, Grass J A, Lund G B, Gittelsohn A P, Osterman F A
Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
J Vasc Interv Radiol. 1993 Jul-Aug;4(4):539-42. doi: 10.1016/s1051-0443(93)71917-x.
This study was undertaken to determine the efficacy of celiac plexus block (CPB) as a method of providing analgesia for percutaneous biliary drainage (PBD).
Thirty-two patients scheduled to undergo PBD were prospectively assigned randomly into placebo (30 mL of normal saline) and treatment (30 mL of 0.25% bupivacaine) CPB groups. Each patient received .03 mg/kg of midazolam for premedication before PBD and had access to a patient-controlled analgesia pump during the procedure. The pump was set to deliver 0.2 mg of midazolam and 25 micrograms of fentanyl per dose with a 3-minute lockout time. Vital signs, including heart rate and blood pressure, were continuously monitored during the procedure and recorded for comparison with baseline values. Patients completed a 10-point visual analogue pain scale following completion of their procedure.
Patients in the placebo and treatment groups self-administered a mean of 2.0 and 1.85 mg of midazolam, respectively (P = .40), and a mean of 247 and 231 micrograms of fentanyl, respectively (P = .40). On a 10-point pain scale, the mean postprocedure versus preprocedure elevation in pain was 2.1 points in the placebo group versus 1.6 points in the treatment group (P = .60). Overall, the degree of satisfaction with the analgesia was equal in both groups.
This study indicates that CPB is not an effective means of providing additional visceral pain relief over and above that which can be accomplished with self-administered intravenous medication for patients who undergo PBD.
本研究旨在确定腹腔神经丛阻滞（CPB）作为经皮胆道引流（PBD）镇痛方法的疗效。
32例计划接受PBD的患者被前瞻性随机分为安慰剂组（30ml生理盐水）和治疗组（30ml 0.25%布比卡因）CPB组。每位患者在PBD前接受0.03mg/kg咪达唑仑进行术前用药，并在手术过程中使用患者自控镇痛泵。该泵设置为每次给药0.2mg咪达唑仑和25μg芬太尼，锁定时间为3分钟。在手术过程中持续监测包括心率和血压在内的生命体征，并记录以与基线值进行比较。患者在手术完成后完成10分制视觉模拟疼痛量表。
安慰剂组和治疗组患者分别平均自行使用2.0mg和1.85mg咪达唑仑（P = 0.40），以及分别平均使用247μg和231μg芬太尼（P = 0.40）。在10分制疼痛量表上，安慰剂组术后疼痛较术前升高的平均值为2.1分，治疗组为1.6分（P = 0.60）。总体而言，两组对镇痛的满意度相同。
本研究表明，对于接受PBD的患者，CPB并非一种有效的提供额外内脏痛缓解的方法，其效果并不优于自行静脉用药所能达到的效果。
