Mulroy M F
Virginia Mason Medical Center, Seattle, Washington, USA.
Reg Anesth. 1996 Nov-Dec;21(6 Suppl):100-4.
Multiple methods of delivery of epidural opioids are acceptable, including bolus injection, continuous infusion, and patient-controlled infusion. The incidence of side effects appears to be reduced with the use of continuous infusion techniques, especially with the liquid-soluble opioids, although these appear to be most effective when infused near the center of the dermatomal pain site. with more distant catheters, the water-soluble opioids are more effective, but there use is associated with more frequent side effects. The lowest dose requirement appears to be associated with PCEA, but further study is needed to confirm the theoretical safety and efficacy of this modality, especially if a constant background infusion is used along with the PCEA. At present, significant advantages appear to be obtainable by adding local anesthetic to the opioid infusion, but the ideal drug and dosage are yet to be determined.
硬膜外给予阿片类药物的多种方式都是可以接受的，包括单次注射、持续输注和患者自控输注。使用持续输注技术，尤其是使用液溶性阿片类药物时，副作用的发生率似乎会降低，尽管这些药物在靠近皮节疼痛部位中心输注时似乎最有效。对于更远处的导管，水溶性阿片类药物更有效，但使用它们会伴随更频繁的副作用。最低剂量需求似乎与患者自控硬膜外镇痛（PCEA）相关，但需要进一步研究来证实这种方式的理论安全性和有效性，特别是如果在PCEA的同时使用持续背景输注。目前，在阿片类药物输注中添加局部麻醉药似乎可获得显著优势，但理想的药物和剂量尚未确定。
