- 期刊
Subarachnoid Fentanyl with Diluted Small-Dose Bupivacaine for Cesarean Section Delivery
剖腹産脊髓內併用低劑量Bupivacaine及Fentanyl之麻醉
摘要
背景：最近幾年臨床上廣泛用腦脊髓軸鴉片類藥物(neuraxial opioid)來加強局部麻醉藥的止痛效果。鴉片類藥物可以與脊髓之鴉片類藥物接受器相結合。産婦於剖腹産手接受脊髓麻醉時血液動力學的穩定是非常重要的。理論上，使用較低劑量之bupivacaine加入fentanyl應有較穩定的血液動力學表現。 方法：將30位ASA physical status Ⅰor Ⅱ接受選擇性剖腹産手術的足月産婦隨機分兩組。M+F組以marcaine(bupivacaine)加入fentanyl，M組則只以bupivacaine爲脊髓內注射藥物。在M+F組施以高比重bupivacaine 5mg(1mg)加入fentanyl 25μg(0.5ml)與腦脊髓液(CSF)0.6ml。在M組中僅以0.5%高比重的bupivacaine 8mg(1.6ml)加入CSF 0.5ml後注射。觀察兩組在血液動力學穩定度，副作用，與止痛時間之差異。 結果：顯示在M+F組，血壓的改變較M組小。嘔吐之發生兩組無明顯差異，而皮膚癢之發生率在M+F組有明顯的增加(93.5%vs. 0)，但發抖之發生率在M+F組則有明顯減少(0 vs.33.3%)。術後止痛時間M+F長(146±47min vs.104±44min)，兩組均有良好的手術與麻醉狀態。一分鐘與五分鐘之Apgar score以及感覺神經恢複到第十胸椎皮節的時間在兩組無明顯差異。 結論：吾人認爲使用低劑量高比重的bupivacaine加fentanyl在剖腹生産手術行脊髓麻醉時可以提供良好的手術狀態，較穩定的血液動力學及較少的副作用，但皮膚癢發生率則較單純使用bupivacaine爲高，但通常是輕度皮膚癢。
並列摘要
Background: The use of neuraxial opioid was very popular in recent years, and they may augment the analgesia produced by local anesthetic through direct binding with the spinal opioid receptors. Hemodynamic stability is very important during Cesarean section. Theoretically, the reduction of local anesthetic by addition of fentanyl would provide better hemodynamic stability and good anesthetic status. Methods: Thirty healthy parturients undergoing Cesarean section were assessed in a randomized fashion. They were divided into two groups. Each subject received 5mg hyperbaric bupivacaine plus 25μg fentanyl (0.5 ml) and cerebrospinal fluid (CSF) 0.6 ml (Group M+F) or 8 mg hyperbaric bupivacaine plus 0.5 ml of CSF (Group M). The effects of hemodynamic stability, side effects, and complete analgesic duration were observed. Results: it was disclosed that the hemodynamic status was more stable in group M+F. The incidence of nausea and vomiting appeared to be not statistically significant between groups. The incidence of pruritus was apparently higher in group M+F (93.5% vs. 0) but the incidence of shivering was much lower in group M+F (0 vs. 33.3%). The complete analgesic duration was longer in group M+F (146±47 min vs. 104±44 mm). There were no significant differences in the anesthetic and surgical status, 1-mm and 5-min Apgar scores, and the time of regression of sensory level to T10. Conclusions: The combination of small-dose bupivacaine with fentanyl could provide more stable hemodynamic status, longer postoperative analgesia, and lower incidence of shivering. The incidence of pruritus in group M+F was high, but it was usually mild.