Rundshagen I, Standl T, Kochs E, Müller M, Schulte am Esch J
Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany.
Reg Anesth. 1997 Mar-Apr;22(2):150-6. doi: 10.1016/s1098-7339(06)80034-9.
Adequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement.
Forty-two patients (mean age, 69 +/- 11 years) were randomly allocated to one of two groups. Group. 1 patients received a constant subarachnoid infusion of 0.6 mg/h of bupivacaine by a patient-controlled device and were allowed to self-administer 0.6 mg every 30 minutes Group 2 patients received a nurse-administered bolus of 3.75 mg of plain bupivacaine on request. Pain was assessed by patients and nurses by a visual analog scale (VAS) every hour. The degree of motor block and the level of analgesia were documented every 4 hours. Hemodynamic and respiratory parameters were recorded hourly. Differences between groups were tested by analysis of variance for repeated measurement.
Technical problems occurred in six patients were more frequent in group 1 but none in group 2. Patient-controlled analgesia resulted in lower pain scores than bolus application during 18 postoperative hours (VAS score 19 +/- 19 mm in group 1 and 39 +/- 30 mm in group 2; P < .01). Lower total doses of bupivacaine were required in group 1 (17.6 +/- 4 mg) than in group 2 (22.3 +/- 7 mg; P < .05). The groups did not differ with respect to the degree of motor block (Bromage score 3.5 +/- 0.5), the sensory level (L1-2 +/- 1), or hemodynamic or respiratory parameters.
In spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.
蛛网膜下腔单次注射布比卡因可使骨科患者术后获得充分的疼痛缓解。本前瞻性随机研究比较了布比卡因单次注射与通过蛛网膜下腔28号微导管进行患者自控输注用于择期髋关节置换术后镇痛的效果。
42例患者（平均年龄69±11岁）被随机分为两组。第1组患者通过患者自控装置接受0.6mg/h布比卡因的持续蛛网膜下腔输注，并可每30分钟自行追加0.6mg。第2组患者根据需要接受护士给予的3.75mg布比卡因单次注射。患者和护士每小时通过视觉模拟评分法（VAS）评估疼痛程度。每4小时记录运动阻滞程度和镇痛平面。每小时记录血流动力学和呼吸参数。组间差异采用重复测量方差分析进行检验。
6例患者出现技术问题，第1组更为常见，第2组无技术问题发生。患者自控镇痛在术后18小时内的疼痛评分低于单次注射（第1组VAS评分为19±19mm，第2组为39±30mm；P<.01）。第1组所需布比卡因的总剂量（17.6±4mg）低于第2组（22.3±7mg；P<.05）。两组在运动阻滞程度（Bromage评分3.5±0.5）、感觉平面（L1-2±1）或血流动力学及呼吸参数方面无差异。
尽管技术问题发生率较高，但通过微导管持续背景输注进行患者自控镇痛比单次注射能提供更有效的术后镇痛，且无血流动力学或呼吸方面的副作用。
