Choe H, Kim J S, Ko S H, Kim D C, Han Y J, Song H S
Department of Anesthesiology, Chonbuk National University Medical School, Chonju, Republic of Korea.
Anesth Analg. 1998 Apr;86(4):786-90. doi: 10.1097/00000539-199804000-00020.
In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization.
Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.
在这项双盲研究中，我们给予患者腰椎硬膜外布比卡因或布比卡因加维拉帕米，以研究钙通道阻滞剂维拉帕米在术后疼痛中可能发挥的作用。100例计划行下腹部手术的患者（ASA身体状况分级为I或II级）被随机分为四组。第1组在切口前15分钟注射10毫升0.5%的硬膜外布比卡因，然后在切口后30分钟注射10毫升硬膜外生理盐水。第2组在切口前注射10毫升硬膜外生理盐水，然后在切口后30分钟注射10毫升0.5%的硬膜外布比卡因。第3组在切口前注射10毫升0.5%的硬膜外布比卡因加5毫克维拉帕米，然后在切口后30分钟注射10毫升硬膜外生理盐水。第4组以相反顺序给予与第3组相同的药物。在每组术后2、6、12、24和48小时评估疼痛和情绪数字评分、镇静评分、亨利王子评分、患者自控术后累积镇痛药物消耗量以及副作用发生率。术后24和48小时，第3组和第4组的累积术后镇痛药物消耗量显著低于第1组和第2组（P<0.05）。四组之间在疼痛、情绪和镇静评分以及副作用发生率方面没有差异。我们得出结论，硬膜外给予维拉帕米可减轻术后疼痛，可能是通过干扰正常的感觉处理过程以及防止中枢敏化的形成。
钙在脊髓水平的疼痛生理学中起着重要作用。我们研究了布比卡因加维拉帕米（钙通道阻滞剂）和单独使用布比卡因的效果。我们证明，硬膜外给予这两种药物的组合比单独使用布比卡因导致更少的术后镇痛药物消耗。
