Tetzlaff J E, Andrish J, O'Hara J, Dilger J, Yoon H J
Department of General Anesthesiology, Cleveland Clinic Foundation, OH 44195, USA.
J Clin Anesth. 1997 Nov;9(7):542-5. doi: 10.1016/s0952-8180(97)00141-4.
To evaluate the quality of pain control achieved with continuous local anesthetic infusion via a femoral nerve catheter, and to determine the optimum concentration of bupivacaine necessary to maintain pain control after full surgical anesthesia is established with 0.5% bupivacaine.
Randomized, prospective study.
Tertiary care teaching center.
25 ASA physical status I and II patients scheduled to undergo arthroscopically-aided anterior cruciate ligament (ACL) reconstruction by one surgeon, and who were willing to accept a femoral nerve catheter for postoperative pain control.
All patients received general anesthesia with propofol/alfentanil (10 ml/1 ml) mixture and nitrous oxide/oxygen (60%/40%) mixture via endotracheal tube. After induction of general anesthesia, a femoral nerve catheter was inserted with the aid of a nerve stimulator, and 20 ml of 0.5% bupivacaine was administered. The surgery was completed in a standard manner and the patients were randomized into three groups for the concentration of local anesthetic to continue the pain relief into the recovery phase. On awakening, all patients were determined to have a functioning femoral nerve catheter. Group 1 received 0.0625% (n = 8) bupivacaine, Group 2 0.125% (n = 9) bupivacaine, and Group 3 0.25% (n = 8) bupivacaine; all doses were initiated in a blinded manner at 0.12 ml/kg/hr. Patients also received intravenous patient-controlled analgesia with morphine via demand mode only, with a 1.0 mg dose and a 6 minute lock-out interval.
Pain was determined at defined intervals by visual analog scale (VAS). Data collected included demographics, VAS scores, and total morphine administered. All patients were pain-free on emergence from general anesthesia. No patient required parenteral opioid for pain control while in the postanesthesia care unit. There were no significant differences in pain scores among groups, and average pain scores (2.5 to 4.0) indicate good pain control throughout the entire hospitalization. There were no complications.
Low concentrations of bupivacaine delivered via femoral nerve catheter after an established femoral nerve block can provide excellent postoperative pain control after ACL reconstruction.
评估通过股神经导管持续输注局部麻醉药实现的疼痛控制质量，并确定在使用0.5%布比卡因建立完全手术麻醉后维持疼痛控制所需的布比卡因最佳浓度。
随机前瞻性研究。
三级护理教学中心。
25例美国麻醉医师协会（ASA）身体状况为I级和II级的患者，计划由一名外科医生进行关节镜辅助下前交叉韧带（ACL）重建手术，且愿意接受股神经导管用于术后疼痛控制。
所有患者通过气管内导管接受丙泊酚/阿芬太尼（10 ml/1 ml）混合物和氧化亚氮/氧气（60%/40%）混合物的全身麻醉。全身麻醉诱导后，在神经刺激器辅助下插入股神经导管，并给予20 ml 0.5%布比卡因。手术以标准方式完成，患者被随机分为三组，以确定局部麻醉药浓度，以便在恢复阶段继续缓解疼痛。苏醒时，所有患者均确定股神经导管功能正常。第1组接受0.0625%（n = 8）布比卡因，第2组接受0.125%（n = 9）布比卡因，第3组接受0.25%（n = 8）布比卡因；所有剂量均以盲法开始，剂量为0.12 ml/kg/小时。患者还仅通过按需模式接受吗啡静脉自控镇痛，剂量为1.0 mg，锁定间隔为6分钟。
通过视觉模拟评分法（VAS）在规定时间间隔测定疼痛程度。收集的数据包括人口统计学资料（译者注：此处原文demographics直译为人口统计学资料，结合上下文推测可能是指患者的年龄、性别等一般信息）、VAS评分和吗啡总用量。所有患者在全身麻醉苏醒时均无疼痛。在麻醉后护理单元期间，没有患者需要胃肠外使用阿片类药物来控制疼痛。各组之间疼痛评分无显著差异，平均疼痛评分（2.5至4.0）表明在整个住院期间疼痛控制良好。没有并发症发生。
在已建立股神经阻滞的情况下，通过股神经导管输注低浓度布比卡因可为ACL重建术后提供出色的术后疼痛控制。
