Rundshagen I, Kochs E, Standl T, Schnabel K, Schulte am Esch J
Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
Acta Anaesthesiol Scand. 1998 Nov;42(10):1215-21. doi: 10.1111/j.1399-6576.1998.tb05280.x.
Patient-controlled analgesia (PCA) with intravenous piritramide and subarachnoid bupivacaine was studied during postoperative pain management in comparison with nurse-administered bolus injections.
Following general anaesthesia (n = 60) patients randomly received either 3.75-7.5 mg i.v. piritramide on demand (group P-Bolus) or via PCA (group P-PCA; initial bolus: 3.75 mg i.v. piritramide, baseline rate: 1 mg/h, demand-dose 1.5 mg, lockout time: 20 min). Following continuous spinal anaesthesia (n = 60; CSA; 28-G spinal catheter) patients randomly received a subarachnoid injection of 1.5 ml bupivacaine 0.25% every 2-4 h (group B-Bolus) or a baseline infusion of 0.5 ml/h bupivacaine 0.125% plus 0.5 ml bupivacaine 0.125% on demand via PCA (group B-PCA; lockout time: 30 min). Pain ratings were assessed hourly by patients using a visual analogue scale (0 = no pain, 100 mm = unbearable pain).
multivariate analysis of variance.
While pain scores did not differ between group P-Bolus and P-PCA, group B-PCA showed the lowest pain ratings (18 +/- 22 mm) differing significantly from group B-Bolus (41 +/- 32 mm; P < 0.001). Group P-PCA required more piritramide than group P-Bolus (46 +/- 15 mg vs. 31 +/- 13 mg, P = 0.001). In contrast group B-PCA required less bupivacaine than group B-Bolus (18 +/- 4 vs. 23 +/- 7 mg, P = 0.002).
PCA with CSA was more effective than nurse-administered bolus-administration of bupivacaine, while the present study failed to show superiority of i.v. PCA over i.v. bolus-administration of piritramide. PCA using the subarachnoid route is a promising concept for treatment of postoperative pain in orthopaedic patients, while the PCA piritramide regime of this study warrants improvement.
在术后疼痛管理中，对静脉注射匹米诺定和蛛网膜下腔注射布比卡因的患者自控镇痛（PCA）与护士给予的大剂量注射进行了研究比较。
全身麻醉后（n = 60），患者随机按需接受3.75 - 7.5 mg静脉注射匹米诺定（P - 大剂量组）或通过PCA接受（P - PCA组；初始大剂量：3.75 mg静脉注射匹米诺定，基线速率：1 mg/h，按需剂量1.5 mg，锁定时间：20分钟）。连续脊麻后（n = 60；CSA；28G脊麻导管），患者随机每2 - 4小时接受一次1.5 ml 0.25%布比卡因蛛网膜下腔注射（B - 大剂量组）或通过PCA按需接受0.5 ml/h 0.125%布比卡因加0.5 ml 0.125%布比卡因的基线输注（B - PCA组；锁定时间：30分钟）。患者每小时使用视觉模拟量表（0 = 无疼痛，100 mm = 难以忍受的疼痛）评估疼痛评分。
多因素方差分析。
P - 大剂量组和P - PCA组的疼痛评分无差异，而B - PCA组的疼痛评分最低（18±22 mm），与B - 大剂量组（41±32 mm；P < 0.001）有显著差异。P - PCA组比P - 大剂量组需要更多的匹米诺定（46±15 mg对31±13 mg，P = 0.001）。相反，B - PCA组比B - 大剂量组需要更少的布比卡因（18±4对23±7 mg，P = 0.002）。
CSA下的PCA比护士给予布比卡因大剂量注射更有效，而本研究未能显示静脉PCA比静脉注射匹米诺定大剂量给药更具优势。蛛网膜下腔途径的PCA是治疗骨科患者术后疼痛的一个有前景的概念，而本研究的PCA匹米诺定方案有待改进。
