0.01%布比卡因和/或0.5微克/毫升肾上腺素可改善剖宫产术后硬膜外芬太尼镇痛效果。

Bupivacaine 0.01% and/or epinephrine 0.5 microg/ml improve epidural fentanyl analgesia after cesarean section.

作者信息

Cohen S, Lowenwirt I, Pantuck C B, Amar D, Pantuck E J

机构信息

Department of Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.

出版信息

Anesthesiology. 1998 Dec;89(6):1354-61. doi: 10.1097/00000542-199812000-00012.

DOI:10.1097/00000542-199812000-00012

PMID:9856709

Abstract

BACKGROUND

The authors studied the addition of bupivacaine and epinephrine, separately and together, to epidural fentanyl to determine whether this improved postcesarean analgesia and reduced the incidence of side effects.

METHODS

After elective cesarean section, 100 parturient patients who received fentanyl (3 microg/ml) epidurally for 48 h were allocated randomly in a double-blinded manner to four groups to receive, in addition to the study solution, 0.01% bupivacaine, 0.5 microg/ml epinephrine, both, or neither. A neurologic assessment of breast-fed neonates was made at 2 and 48 h of life. Plasma fentanyl concentrations were determined in a subset of patients at intervals after treatment.

RESULTS

Patients receiving fentanyl alone made more attempts at patient-controlled analgesia (P < 0.01), required a greater total dose of fentanyl (P < 0.01), reported more pain (P < 0.003) and less satisfaction (P < 0.003), and had more nausea and urinary retention (P < 0.05) than all other groups. Patients who received bupivacaine with or without epinephrine had better overall satisfaction scores than those who did not receive bupivacaine (P < 0.001), and they required less fentanyl (P < 0.02) than patients who received fentanyl with only epinephrine. Motor blockade or orthostatic hypotension did not develop in any patient, and all patients could ambulate without difficulty. Neurobehavioral scores, which were similar among all neonates, were within the normal range. Plasma concentrations of fentanyl increased after epinephrine-containing solutions were discontinued.

CONCLUSIONS

During the conditions of this study, the addition of epinephrine and bupivacaine to a 3-microg/ml epidural fentanyl solution for postcesarean section pain relief provided superior analgesia compared with fentanyl alone or fentanyl with epinephrine. Whether increasing the concentration of fentanyl alone might improve the efficacy of fentanyl remains unclear.

摘要

背景

作者研究了分别及联合将布比卡因和肾上腺素添加至硬膜外芬太尼中，以确定这是否能改善剖宫产术后镇痛并降低副作用的发生率。

方法

择期剖宫产术后，100例接受硬膜外芬太尼（3微克/毫升）48小时的产妇被随机双盲分配至四组，除研究溶液外，分别接受0.01%布比卡因、0.5微克/毫升肾上腺素、两者联合或两者均不接受。在出生后2小时和48小时对母乳喂养的新生儿进行神经学评估。在治疗后的不同时间间隔对部分患者测定血浆芬太尼浓度。

结果

与所有其他组相比，仅接受芬太尼的患者进行患者自控镇痛的尝试更多（P<0.01），需要的芬太尼总剂量更大（P<0.01），报告的疼痛更多（P<0.003）且满意度更低（P<0.003），恶心和尿潴留更多（P<0.05）。接受布比卡因加或不加肾上腺素的患者总体满意度得分高于未接受布比卡因的患者（P<0.001），且他们需要的芬太尼比仅接受肾上腺素加芬太尼的患者少（P<0.02）。所有患者均未出现运动阻滞或体位性低血压，所有患者均能轻松行走。所有新生儿的神经行为评分相似且在正常范围内。含肾上腺素溶液停用后，芬太尼的血浆浓度升高。