Vercauteren M P, Saldien V, Bosschaerts P, Adriaensen H A
Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium.
Eur J Anaesthesiol. 1996 Nov;13(6):571-6. doi: 10.1046/j.1365-2346.1996.d01-412.x.
Sufentanil or a sufentanil-clonidine combination was evaluated to determine whether the basal rate in patient-controlled epidural analgesia (PCEA) might affect the daily consumption, quality of analgesia or incidence of side effects. Following Caesarean section delivery, 60 patients were randomly assigned to receive one of the four following PCA regimens (15 patients per group) for the relief of post-operative pain by the epidural route: sufentanil 2 micrograms mL-1 in 0.9% NaCl, demand dose 5 micrograms i.e. 2.5 mL, (group S+ with, group S without an infusion at 2.5 mL hr-1) or sufentanil 2 micrograms mL-1 + clonidine 3 micrograms mL-1, demand dose 5 micrograms sufentanil + 7.5 micrograms clonidine i.e. 2.5 mL (group SC+ with and SC without an infusion of 2.5 ml hr-1). The other PCA settings (Bard I PCA pump) were a lock out of interval of 10 min and a 1 h limit of 20 micrograms sufentanil and 30 micrograms clonidine i.e. 10 mL. The parameters measured were the analgesic drug consumption and number of dose demands during the first 24 h, pain scores at 6 h intervals, side effects and quality of sleep. The concurrent infusion increased the dose requirements regardless of the content of the syringe. Consumption of sufentanil was the highest in those patients receiving the plain solution with a basal infusion. Clonidine addition reduced the dose requirements but only significantly in those receiving the background infusion. Patients treated with the mixture tended to reach lower pain scores than those receiving sufentanil only without basal rate. Patients receiving the mixture with basal rate requested significantly fewer additional demands compared with the three other groups, but this did not influence the quality of sleep. Since side effects were more frequently registered in the patients in this group, it was concluded that the optimum regimen was the sufentanil-clonidine combination but with deletion of the basal rate.
对舒芬太尼或舒芬太尼 - 可乐定联合用药进行评估，以确定患者自控硬膜外镇痛（PCEA）的基础输注速率是否会影响每日药物消耗量、镇痛质量或副作用发生率。剖宫产术后，60例患者被随机分配接受以下四种PCA方案之一（每组15例），通过硬膜外途径缓解术后疼痛：0.9%氯化钠溶液中含舒芬太尼2微克/毫升，单次给药剂量5微克即2.5毫升，（S +组有、S组无2.5毫升/小时的输注）或舒芬太尼2微克/毫升 + 可乐定3微克/毫升，单次给药剂量为5微克舒芬太尼 + 7.5微克可乐定即2.5毫升（SC +组有、SC组无2.5毫升/小时的输注）。其他PCA设置（巴德I型PCA泵）为锁定时间间隔10分钟，1小时内舒芬太尼限量20微克、可乐定限量30微克即10毫升。测量的参数包括最初24小时内的镇痛药消耗量和给药需求次数、每6小时间隔的疼痛评分、副作用及睡眠质量。无论注射器内药物成分如何，同时进行输注都会增加给药需求量。接受单纯溶液并进行基础输注的患者中舒芬太尼消耗量最高。添加可乐定可降低给药需求量，但仅在接受背景输注的患者中显著降低。与仅接受舒芬太尼且无基础输注速率的患者相比，接受混合药物治疗的患者疼痛评分往往更低。与其他三组相比，接受基础输注速率混合药物治疗的患者额外给药需求量显著更少，但这并未影响睡眠质量。由于该组患者副作用记录更为频繁，得出的结论是最佳方案为舒芬太尼 - 可乐定联合用药，但应去除基础输注速率。
