Watters J M, March R J, Desai D, Monteith K, Hurtig J B
Department of Surgery, University of Ottawa, Ottawa Civic Hospital, Ontario, Canada.
Can J Anaesth. 1993 Apr;40(4):314-9. doi: 10.1007/BF03009628.
Our objective was to determine the effect of perioperative epidural anaesthesia and analgesia on the increase in energy expenditure which accompanies major elective abdominal surgery in a prospective, randomized study. Eight patients undergoing elective resections of the colon and/or rectum received general anaesthesia alone (nitrous oxide, oxygen, and isoflurane, supplemented with intravenous fentanyl to a maximum of 10 micrograms.kg-1), and 12 patients received perioperative epidural anaesthesia and analgesia using lidocaine (carbonated lidocaine 2% with epinephrine 1:200,000, 20 ml over 30 min) and morphine (preservative-free morphine 0.10 mg.kg-1 after catheter insertion and 0.05 to 0.10 mg.kg-1 every 12 hr as needed until the morning following surgery) via a lower lumbar catheter in addition to general anaesthesia. Respiratory gas exchange was measured using a metabolic cart and canopy system early on the morning of surgery, six hours postoperatively, and on the first and second postoperative mornings. Parenteral analgesic administration (P < 0.001) and visual analogue pain scores (P < 0.05) were lower in the patients receiving epidural anaesthesia and time to first parenteral analgesia was longer (P < 0.005). Oxygen consumption, carbon dioxide production, and energy expenditure increased after surgery (all P < 0.001) but were very similar in the two groups (all P > or = 0.8) before and after surgery. Despite substantial effects on postoperative pain, we conclude that oxygen consumption and energy expenditure following major abdominal surgery are not diminished by perioperative epidural anaesthesia and analgesia.
我们的目标是通过一项前瞻性随机研究，确定围手术期硬膜外麻醉和镇痛对择期腹部大手术伴随的能量消耗增加的影响。8例接受结肠和/或直肠择期切除术的患者仅接受全身麻醉（氧化亚氮、氧气和异氟烷，静脉补充芬太尼，最大剂量为10微克/千克），12例患者除全身麻醉外，还通过低位腰段导管接受围手术期硬膜外麻醉和镇痛，使用利多卡因（2%碳酸利多卡因加1:200,000肾上腺素，30分钟内注入20毫升）和吗啡（置管后给予无防腐剂吗啡0.10毫克/千克，术后根据需要每12小时给予0.05至0.10毫克/千克，直至术后次日早晨）。在手术当天早晨、术后6小时以及术后第一和第二个早晨，使用代谢车和面罩系统测量呼吸气体交换。接受硬膜外麻醉的患者，其胃肠外镇痛药物的使用量更低（P<0.001），视觉模拟疼痛评分更低（P<0.05），首次使用胃肠外镇痛药物的时间更长（P<0.005）。术后氧耗量、二氧化碳生成量和能量消耗均增加（均P<0.001），但两组在手术前后非常相似（均P≥0.8）。尽管围手术期硬膜外麻醉和镇痛对术后疼痛有显著影响，但我们得出结论，腹部大手术后的氧耗量和能量消耗并未因围手术期硬膜外麻醉和镇痛而减少。
