Hering R, Schumacher T, Müller H
Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Rheinischen Friedrich-Wilhelms-Universität Bonn.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Nov;31(9):550-5. doi: 10.1055/s-2007-995983.
The purpose of this study was to investigate whether continuous epidural administration of combined low dose local anaesthetic, opioid and clonidine can provide sufficient postoperative analgesia after major abdominal surgery.
45 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into three groups. Prior to surgery all patients received an epidural catheter before induction of general anaesthesia. After 90 minutes a 10 ml bolus of the study solution was given via the epidural catheter followed by a continuous infusion of 5 ml/h until the end of surgery and further on 5-8 ml/h for 24 hours postoperatively. The solutions consisted of 50 micrograms sufentanil in 50 ml 0.125% bupivacaine (group 1), 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 2) and 50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 3). Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side-effects within the first 24 hours postoperatively. A standardised interview on analgesia and side-effects was held two days after surgery.
At rest excellent analgesia could be provided by all of the tested drug solutions. On exercise we evaluated lower pain scores in group 3 (1.9 +/- 1.1) compared to group 1 (2.8 +/- 1.6) or group 2 (3.8 +/- 2.1) (2 vs 3 p < 0.05). Severe side effects such as respiratory depression or drop of heart rate or blood pressure did not occur.
Epidural administration of drug solutions containing a low dose local anaesthetic, opioid and alpha 2-agonist, provides excellent analgesia after major abdominal surgery. Patients at rest can be treated very effectively with both a combination of only two or with all of the tested drugs. On exercise the mixture containing all analgesics was more efficient than the solutions with only two of the tested drugs. Severe side effects such as respiratory depression or cardiovascular instability were not seen.
本研究旨在调查连续硬膜外给予低剂量局部麻醉药、阿片类药物和可乐定联合用药能否为腹部大手术后提供充分的术后镇痛。
45例计划行腹部大手术的患者（ASA I - III级）被随机分为三组。手术前，所有患者在全身麻醉诱导前均置入硬膜外导管。90分钟后，经硬膜外导管给予10ml研究溶液推注，随后以5ml/h持续输注直至手术结束，术后24小时继续以5 - 8ml/h输注。溶液组成如下：50ml 0.125%布比卡因中含50微克舒芬太尼（第1组），50ml 0.125%布比卡因中含150微克可乐定（第2组），50ml 0.125%布比卡因中含50微克舒芬太尼 + 150微克可乐定（第3组）。测量指标包括输注药物溶液的总剂量、静息和运动时的疼痛（采用视觉模拟评分法）、心肺数据以及术后24小时内的副作用。术后两天进行关于镇痛和副作用的标准化访谈。
所有测试药物溶液在静息时均可提供良好的镇痛效果。在运动时，我们评估第3组（1.9±1.1）的疼痛评分低于第1组（2.8±1.6）或第2组（3.8±2.1）（第2组与第3组比较，p < 0.05）。未发生严重副作用，如呼吸抑制、心率或血压下降。
硬膜外给予含低剂量局部麻醉药、阿片类药物和α2激动剂的药物溶液，在腹部大手术后可提供良好的镇痛效果。仅两种药物联合或所有测试药物联合使用，均可非常有效地治疗静息状态的患者。在运动时，含所有镇痛药的混合溶液比仅含两种测试药物的溶液更有效。未观察到严重副作用，如呼吸抑制或心血管不稳定。
