Schneider R F, Villamena P C, Harvey J, Surick B G, Surick I W, Beattie E J
Beth Israel Medical Center, New York.
Chest. 1993 Feb;103(2):414-6. doi: 10.1378/chest.103.2.414.
Intrapleural bupivacaine has been reported to be effective for analgesia following cholecystectomy and thoracic surgery. Twenty patients who had a posterolateral thoracotomy were studied in a randomized, double-blind, placebo-controlled fashion. Patients were assigned to receive intrapleural administration of either 0.5 percent bupivacaine or saline solution every 4 h for 12 doses postoperatively, as well as narcotic analgesics as needed for additional pain control. Pain was assessed using a visual analogue scale. Narcotic analgesic use, duration of hospitalization, and the development of complications were recorded. There were nine evaluable patients who received bupivacaine, and ten patients who received placebo. The age, sex, and type of operation were similar in the two groups, and the procedures were performed by the same two surgeons. The mean pain score at 24 h postoperatively was 5.8 +/- 0.8 in the bupivacaine group and 6.0 +/- 0.6 in the placebo group. At 48 h, the scores were 4.6 +/- 0.8 in the bupivacaine group and 5.1 +/- 0.9 in the placebo group. The mean dose of morphine sulfate or equianalgesic dose of meperidine during the first 24 h was 13.9 +/- 3.7 mg in the bupivacaine group and 12.6 +/- 1.8 mg in the placebo group, and during the next 24 h it was 40.0 +/- 13.4 mg in the bupivacaine group and 38.0 +/- 9.2 mg in the placebo group. The mean duration of hospitalization was 12.8 +/- 3.2 days in the bupivacaine group and 12.1 +/- 2.9 days in the placebo group. Two patients who received bupivacaine and three patients who received placebo had development of pneumonia or atelectasis postoperatively. There was no statistically significant difference in any parameter between those who received bupivacaine and those who received placebo. Thus, there was no subjective or objective clinical benefit of this method of postoperative analgesia compared with placebo following posterolateral thoracotomy.
据报道，胸膜内注射布比卡因对胆囊切除术和胸科手术后的镇痛有效。对20例行后外侧开胸手术的患者进行了一项随机、双盲、安慰剂对照研究。患者被分配在术后每4小时接受一次胸膜内注射0.5%布比卡因或生理盐水，共12剂，以及根据需要使用麻醉性镇痛药以进一步控制疼痛。使用视觉模拟量表评估疼痛。记录麻醉性镇痛药的使用情况、住院时间和并发症的发生情况。有9例可评估患者接受了布比卡因，10例患者接受了安慰剂。两组患者的年龄、性别和手术类型相似，手术由同两位外科医生进行。布比卡因组术后24小时的平均疼痛评分为5.8±0.8，安慰剂组为6.0±0.6。48小时时，布比卡因组的评分为4.6±0.8，安慰剂组为5.1±0.9。布比卡因组在前24小时硫酸吗啡的平均剂量或等效镇痛剂量的哌替啶为13.9±3.7mg，安慰剂组为12.6±1.8mg，在接下来的24小时内，布比卡因组为40.0±13.4mg，安慰剂组为38.0±9.2mg。布比卡因组的平均住院时间为12.8±3.2天，安慰剂组为12.1±2.9天。接受布比卡因的2例患者和接受安慰剂的3例患者术后发生了肺炎或肺不张。接受布比卡因的患者和接受安慰剂的患者在任何参数上均无统计学显著差异。因此，与后外侧开胸术后的安慰剂相比，这种术后镇痛方法没有主观或客观的临床益处。
