Hering R, Schumacher T, Müller H
Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Nov;32(11):659-64. doi: 10.1055/s-2007-995132.
The purpose of our study was to find out whether patient-controlled epidural administration (PCEA) of a mixture containing a low-dose local anaesthetic, opioid and alpha 2-agonist provides as good or better postoperative analgesia as continuous epidural administration of the same analgetic solution.
30 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into 2 groups. 90 minutes after induction of general anaesthesia all patients received a continuous epidural infusion of 5 ml/h of the analgetic solution (50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine) until the end of surgery. Immediately postoperatively the patients of group A received a continuous infusion of the study solution (5-8 ml/h), the patients of group B received a baseline continuous epidural infusion (3 ml/h), additionally they could self-administer 5 ml boli via a PCEA device. 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 2 days after surgery.
The PCEA group demanded less epidural analgesics (gr. B: 112 +/- 33 ml vs. gr. A: 135 +/- 20 ml) p < 0.01). Both continuous epidural infusion and patient-controlled administration provided very good analgesia at rest (gr. A: VAS 0.4 +/- 0.4 and gr. B: VAS 0.4 +/- 0.5) (n.s.). On exercise continuous epidural infusion of analgesics resulted in significantly lower pain scores (gr. A: 1.9 +/- 1.1) than patient-controlled application (gr. B: 3.4 +/- 1.1) (p < 0.01). We did not notice severe side effects such as respiratory depression or drop of heart rate or blood pressure.
In patients at rest both continuous and patient-controlled epidural administration of analgesics provides excellent analgesia after major abdominal surgery. Contrariwise, patients on exercise who could use a PCA-device experienced more pain compared to those with a continuous epidural infusion technique. On the other hand the patients of the PCA-group consumed less epidural analgesics. We did not notice any severe side effects such as respiratory depression or cardiovascular instability during the study.
我们研究的目的是确定含低剂量局部麻醉药、阿片类药物和α2激动剂的混合液经患者自控硬膜外给药（PCEA）是否能提供与相同镇痛溶液持续硬膜外给药一样好或更好的术后镇痛效果。
30例计划行腹部大手术的患者（ASA I - III级）被随机分为2组。全身麻醉诱导90分钟后，所有患者均接受5ml/h的镇痛溶液（50ml 0.125%布比卡因中含50微克舒芬太尼 + 150微克可乐定）持续硬膜外输注直至手术结束。术后即刻，A组患者接受研究溶液持续输注（5 - 8ml/h），B组患者接受基线持续硬膜外输注（3ml/h），此外他们可通过PCEA装置自行给药5ml bolus。测量指标包括输注药物溶液的总量、术后24小时内静息和运动时的疼痛（采用视觉模拟评分法）、心肺数据及副作用。术后2天进行关于镇痛和副作用的标准化访谈。
PCEA组所需硬膜外镇痛药较少（B组：112 ± 33ml vs. A组：135 ± 20ml）（p < 0.01）。持续硬膜外输注和患者自控给药在静息时均提供了非常好的镇痛效果（A组：VAS 0.4 ± 0.4，B组：VAS 0.4 ± 0.5）（无统计学差异）。运动时，持续硬膜外输注镇痛药导致的疼痛评分显著低于患者自控给药（A组：1.9 ± 1.1，B组：3.4 ± 1.1）（p < 0.01）。我们未观察到严重副作用，如呼吸抑制、心率或血压下降。
腹部大手术后，静息患者采用持续硬膜外给药和患者自控硬膜外给药均能提供良好的镇痛效果。相反，与采用持续硬膜外输注技术的患者相比，能使用PCA装置进行运动的患者疼痛更明显。另一方面PCA组患者消耗的硬膜外镇痛药较少。研究期间我们未观察到任何严重副作用，如呼吸抑制或心血管不稳定。
