Terai T, Yukioka H, Fujii T, Yabe M, Asada A
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School.
Masui. 1997 Jan;46(1):100-4.
In a randomized double-blind study, the use of continuous epidural lidocaine during surgery combined with preoperative epidural morphine was compared with that of preoperative epidural morphine alone for postoperative analgesia in 20 patients undergoing hepatectomy. Morphine 2 mg was administered through a catheter inserted epidurally at T10-11 before surgery, followed by continuous epidural administration of 1% lidocaine 5ml.h-1 in group Lid (n = 10) or normal saline 5ml.h-1 in group NS (n = 10) during surgery. Anesthesia was maintained with N2O-O2-isoflurane in both groups. On admission to the ICU, the visual analog scale score (VAS; mm) was 20 +/- 7 (mean +/- SE) in group Lid and 38 +/- 10 in group NS, and the number of patient with VAS < or = 30 was 9 in group Lid and 4 in group NS; these differences were significant (P < 0.05). Pain score during mobilization in group Lid was significantly lower than that in group NS (P < 0.05). All patients in both groups had adequate analgesia for the remainder of their stay in the ICU. No patient had any serious adverse effect. We conclude that continuous epidural administration of lidocaine during hepatectomy combined with administration of epidural morphine just before surgery results in better pain relief during the early postoperative period than that obtained with epidural morphine alone, and is without serious side effects.
在一项随机双盲研究中，对20例接受肝切除术的患者，比较了术中持续硬膜外给予利多卡因联合术前硬膜外给予吗啡与单纯术前硬膜外给予吗啡用于术后镇痛的效果。术前在T10 - 11间隙硬膜外插入导管给予吗啡2mg，然后Lid组（n = 10）在术中持续硬膜外给予1%利多卡因5ml·h⁻¹，NS组（n = 10）在术中持续硬膜外给予生理盐水5ml·h⁻¹。两组均用N₂O - O₂ - 异氟烷维持麻醉。入重症监护病房（ICU）时，Lid组视觉模拟评分（VAS；mm）为20±7（均值±标准误），NS组为38±10，VAS≤30的患者人数Lid组为9例，NS组为4例；这些差异具有统计学意义（P < 0.05）。Lid组活动时的疼痛评分显著低于NS组（P < 0.05）。两组所有患者在ICU住院期间其余时间均有足够的镇痛效果。无患者出现任何严重不良反应。我们得出结论，肝切除术中持续硬膜外给予利多卡因并在术前给予硬膜外吗啡，比单纯硬膜外给予吗啡在术后早期能更好地缓解疼痛，且无严重副作用。
