Boylan J F, Katz J, Kavanagh B P, Klinck J R, Cheng D C, DeMajo W C, Walker P M, Johnston K W, Sandler A N
Department of Anaesthesia, The Toronto Hospital, Ontario, Canada.
Anesthesiology. 1998 Sep;89(3):585-93. doi: 10.1097/00000542-199809000-00006.
The efficacy and effects of epidural analgesia compared with patient-controlled analgesia (PCA) have not been reported in patients undergoing major vascular surgery. We compared the effects of epidural bupivacaine-morphine with those of intravenous PCA morphine after elective infrarenal aortic surgery.
Forty patients classified as American Society of Anesthesiologists physical status 2 or 3 received general anesthesia plus postoperative PCA using morphine sulfate (group PCA; n = 21) or general anesthesia plus perioperative epidural morphine-bupivacaine (group EPI; n = 19) during a period of 48 h. During operation, EPI patients received 0.05 mg/kg epidural morphine and 5 ml 0.25% bupivacaine followed by an infusion of 0.125% bupivacaine with 0.1% morphine (0.1 mg/ ml); group PCA received 0.1 mg/kg intravenous morphine sulfate. Continuous electrocardiographic monitoring (V4 and V5 leads) was performed from the night before surgery until 48 h afterward. Respiratory inductive plethysmographic data were recorded after tracheal extubation. Visual analog pain scores at rest and after movement were performed every 4 h after extubation.
Nurse-administered intravenous morphine and time to tracheal extubation were less in group EPI, as were visual analog pain scores at rest and after movement from 20 to 48 h. Complications and the duration of intensive care unit and hospital stay were comparable. There was a similar, low incidence of postoperative apneas, slow respiratory rates, desaturation, and S-T segment depression.
Epidural morphine-bupivacaine is associated with reduced early postoperative intravenous opioid requirements, more rapid tracheal extubation, and superior analgesia after abdominal aortic surgery, with comparable respiratory effects.
在接受大血管手术的患者中，与患者自控镇痛（PCA）相比，硬膜外镇痛的疗效和效果尚未见报道。我们比较了择期肾下腹主动脉手术后硬膜外布比卡因-吗啡与静脉PCA吗啡的效果。
40例美国麻醉医师协会身体状况分级为2或3级的患者，在48小时内接受全身麻醉加术后PCA使用硫酸吗啡（PCA组；n = 21）或全身麻醉加围手术期硬膜外吗啡-布比卡因（EPI组；n = 19）。手术期间，EPI组患者接受0.05 mg/kg硬膜外吗啡和5 ml 0.25%布比卡因，随后输注含0.1%吗啡（0.1 mg/ml）的0.125%布比卡因；PCA组接受0.1 mg/kg静脉注射硫酸吗啡。从手术前一晚至术后48小时进行连续心电图监测（V4和V5导联）。气管拔管后记录呼吸感应体积描记数据。拔管后每4小时进行静息和活动后的视觉模拟疼痛评分。
EPI组护士给予的静脉吗啡量和气管拔管时间较短，静息和20至48小时活动后的视觉模拟疼痛评分也较低。并发症以及重症监护病房和住院时间相当。术后呼吸暂停、呼吸频率减慢、血氧饱和度降低和ST段压低的发生率相似且较低。
硬膜外吗啡-布比卡因与术后早期静脉阿片类药物需求量减少、气管拔管更快以及腹主动脉手术后镇痛效果更好相关，呼吸效应相当。
