Scholz J, Steinfath M, Koch C, Rundshagen I
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Anaesthesist. 1997 Sep;46 Suppl 3:S154-8.
The administration of epidural opioids is alternatively used in the management of postoperative analgesia. However, the administration is associated with side effects, including respiratory depression, somnolence and pruritus. A rational opioid selection between the hydrophilic and lipophilic opioids morphine, hydromorphone, alfentanil, fentanyl and sufentanil is discussed in this mini-review. Thus, the administration of the lipophilic opioid sufentanil might has some advantages. Notwithstanding, epidural opioid administration alone offers no marked clinical advantages compared to the intravenous route. In future, reduced doses of lipophilic opioids and local anaesthetics like bupivacaine 0.05-0.1% may provide benefits over the use of either drug alone and may offer marked clinical advantages over the intravenous route of opioids alone. The same holds true for alpha 2-adrenoceptor agonists as adjuvants. However, multicenter dose-ranging studies are necessary to determine both the ideal concentrations of the drug combinations and the general outcome. Moreover, we must also determine cost effectiveness for our postoperative analgesic techniques.
硬膜外给予阿片类药物也用于术后镇痛管理。然而，这种给药方式会带来副作用，包括呼吸抑制、嗜睡和瘙痒。本综述讨论了在亲水性和脂溶性阿片类药物吗啡、氢吗啡酮、阿芬太尼、芬太尼和舒芬太尼之间进行合理的阿片类药物选择。因此，给予脂溶性阿片类药物舒芬太尼可能具有一些优势。尽管如此，与静脉途径相比，单纯硬膜外给予阿片类药物并没有明显的临床优势。未来，减少脂溶性阿片类药物和如0.05 - 0.1%布比卡因等局部麻醉剂的剂量，可能比单独使用任何一种药物更有益，并且可能比单纯静脉给予阿片类药物具有明显的临床优势。α2肾上腺素能受体激动剂作为辅助药物也是如此。然而，需要进行多中心剂量范围研究来确定药物组合的理想浓度和总体结果。此外，我们还必须确定术后镇痛技术的成本效益。
