Lin B C, Lin P C, Lai Y Y, Huang S J, Yeh F C
Department of Anesthesiology, Buddhist TZ'U-CHI General Hospital, Hualien, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1998 Sep;36(3):143-8.
Opioid added to local anesthetic for spinal anesthesia was first introduced into clinical practice in 1979 with intrathecal morphine as a forerunner. As morphine is water soluble and has prolonged action, late respiratory depression following spinal anesthesia is not infrequent and is the most serious complication that causes our concern. Sufentanil which is more hydrophobic than morphine also with shorter duration of action and quicker onset when injected into the subarchnoid space could be more effective and a safer drug as an adjuvant to local anesthetic in spinal anesthesia.
Forty-one parturients who had given consent to spinal anesthesia for Cesarean delivery, were anesthetized with 12.5 mg of 0.5% bupivacaine alone or in combination with 10 micrograms sufentanil in a randomized double blind manner. They were assigned either to C group (Control group) in which nothing is added to the local anesthetic and S group (Study group) in which sufentanil was added to the local anesthetic.
Perioperatively, hypotension occurred more in S group (17 against 11) but chest discomfort was less (3 against 7). Within 3 h after anesthesia 3 out of 19 parturients in S group requested analgesics but almost all parturients in C group did so.
The addition of intrathecal sufentanil to 0.5% bupivacaine for spinal anesthesia improved perioperative discomfort and significantly reduced the demand of post-operative analgesia but on the other hands, it tended to increase perioperative hypotension and cause mild pruritus.
1979年，以鞘内注射吗啡为先驱，将阿片类药物添加到局部麻醉剂中用于脊髓麻醉首次引入临床实践。由于吗啡是水溶性的且作用时间延长，脊髓麻醉后迟发性呼吸抑制并不罕见，是引起我们关注的最严重并发症。舒芬太尼比吗啡更具疏水性，作用时间更短，注入蛛网膜下腔时起效更快，作为脊髓麻醉中局部麻醉剂的佐剂可能更有效且更安全。
41名同意接受剖宫产脊髓麻醉的产妇，以随机双盲方式用12.5mg 0.5%布比卡因单独麻醉或与10微克舒芬太尼联合麻醉。她们被分为C组（对照组），局部麻醉剂中不添加任何东西，以及S组（研究组），局部麻醉剂中添加舒芬太尼。
围手术期，S组低血压发生率更高（17例对11例），但胸部不适较少（3例对7例）。麻醉后3小时内，S组19名产妇中有3名需要镇痛药，而C组几乎所有产妇都需要。
在0.5%布比卡因中添加鞘内舒芬太尼用于脊髓麻醉可改善围手术期不适并显著减少术后镇痛需求，但另一方面，它倾向于增加围手术期低血压并引起轻度瘙痒。
