Blake D W, Stainsby G V, Bjorksten A R, Dawson P J
Department of Anaesthesia, Royal Melbourne Hospital, Victoria.
Anaesth Intensive Care. 1998 Dec;26(6):630-5. doi: 10.1177/0310057X9802600603.
In a double-blind, randomized, crossover study of 25 patients after abdominal aortic surgery, we compared patient-controlled analgesia (PCA) with epidural versus intravenous pethidine. All patients received continuous epidural infusions of 0.125% bupivacaine adjusted to maintain appropriate sensory levels. The 48 hour study period commenced 36 to 48 hours after surgery and covered postoperative days 2 and 3. There was a crossover in PCA mode (epidural or intravenous) after 24 hours. Plasma pethidine concentration at the end of each 24 hour period and the total 24 hour pethidine dose did not change significantly between postoperative days 2 and 3. Pethidine plasma concentration was lower after 24 hours epidural than after intravenous PCA [125 (SD 108) ng/ml versus 171 (SD 107) ng/ml, P = 0.03], although pethidine dose did not differ significantly [mean 147 (SD 124) mg/24 h]. Visual analog pain scores (VAS) did not differ significantly between postoperative days 2 and 3, or at rest between epidural and i.v. groups. However, VAS with coughing and with abdominal palpation were lower in the epidural PCA group (P = 0.05, 0.008). With a background epidural infusion of 0.125% bupivacaine, PCA with epidural pethidine provided better pain control than PCA intravenous pethidine and this was achieved at lower plasma pethidine concentrations.
在一项针对25例腹主动脉手术后患者的双盲、随机、交叉研究中，我们比较了硬膜外与静脉注射哌替啶的患者自控镇痛（PCA）效果。所有患者均接受0.125%布比卡因的持续硬膜外输注，并进行调整以维持适当的感觉平面。48小时的研究期在手术后36至48小时开始，涵盖术后第2天和第3天。24小时后PCA模式（硬膜外或静脉）交叉。术后第2天和第3天之间，每24小时末期的血浆哌替啶浓度和24小时哌替啶总剂量均无显著变化。硬膜外PCA 24小时后的哌替啶血浆浓度低于静脉PCA [125（标准差108）ng/ml对171（标准差107）ng/ml，P = 0.03]，尽管哌替啶剂量无显著差异[平均147（标准差124）mg/24小时]。视觉模拟疼痛评分（VAS）在术后第2天和第3天之间，或硬膜外组与静脉组静息时无显著差异。然而，硬膜外PCA组咳嗽和腹部触诊时的VAS较低（P = 0.05，0.008）。在0.125%布比卡因硬膜外背景输注的情况下，硬膜外注射哌替啶的PCA比静脉注射哌替啶的PCA能提供更好的疼痛控制，且这是在较低的血浆哌替啶浓度下实现的。
