- 期刊
COMPARISON OF CONTINUOUS EPIDURAL INFUSION OF FENTANYL AND FENTANYL-BUPIV ACAINE FOR POST CHOLECYSTECOMY PAIN CONTROL
硬膜外點滴Fentanyl或Fentanyl Bupivacaine對膽囊切除術後止痛效果的比較
摘要
Epidural narcotics has been shown to produce profound and long-lasting analgesia. It has been suggested that lipid-soluble narcotics such as fentanyl, because of their short transit time in the CSF, are less likely to be associated with delayed respiratory depression and side effects. We tried to combine low concentrations of fentanyl with bupivacaine to minimize side effects and to see if synergistic effect existed. Forty ASA physical status I or II patients who present for cholecy-stectomy were included in the trial. Before surgery a thoracic epidural catheter was inserted and pain control began when patients became fully awake and complained of pain in the recovery room after surgery. Patients were randomized in a double-blind fashion to one of four groups. Patients in group I were given epidural infusions of fentanyl 0.001%; patients in group 2 receIved fentanyl 0.001% mixed with bupivacaine 0.1%; patients in group 3 received fentanyl 0.0005%; patients in group 4 received fetanyl 0.0005% mixed with bupivacaine 0.1%. A continuous epidural infusion of these drugs began at a rate of 10mL/h after a 5-mLbolus of the solution. Pain relief was assessed with visual analogue pain scale. Respiratory rates, vital signs, and mental status were assessed hourly. Except the group 3, the degree of analgesia achieved was similarly satisfactory in all other groups. There was no respiratory depression developed in either group. Motor block was minimal or absent in all groups. The incidence of nausea and pruritis was significant less in group 3 and group 4. In conclusion, the continuous infusion of dilute bupivacaine with fentanyl provides synergistic analgesia with minimal side effects.
並列摘要
目前已知硬脊膜外麻藥的施與，具有很强與長時間的止痛效果。許多論文指出，脂溶性較强的一些麻藥Fentanyl因爲存在CSF的時間較短，比較不會引起中樞性的呼吸抑制與其他的副作用，若使用硬膜外點滴方式，很適合作爲手術後止痛。我們嘗試合併稀釋的麻藥與局部麻醉劑，來研究其止痛效果，及是否能減少個別的副作用四十位ASA I或II做膽囊切除術的病人在開刀前於胸椎硬脊膜外置一導管，術後於麻醉恢復室完全清醒，感覺疼痛時才開始給藥我們將病人任意分成四組，第期的點滴液内含Fentanyl0.001％，第二組含Fentanyl0.001％及Bupivacaine0.1％，第三組含Fentanyl0.0005％，第四組含Fentanyl0.0005％Bupivacaine0.1％。在注射了5cc的藥後，以每小時10cc的速度連續時滴，我們依類比式疼痛計分表，來評估疼痛的情況，每小時評估一次，並觀察是否有其他副作用，有無麻木與肌肉無力的現象，需不需要其他的止痛劑。每一小時並測量呼吸次數、生命徵、清醒度。結果顯示，在給藥後病人很快就能獲得止痛效果，二十分鐘以後，幾乎可達最高止痛效果的百分之九十，一小時後，第一組病人的疼痛分數由8.23±1.45降至2.56±1.52，第二組由8.65±1.12降至1.85±1.23，第三組由8.45±1.33降至4.53±4.53±1.36，第四組由8.72±1.13降至2.89±1.56。除了第三組病人外，滿意程度相當。呼吸次數在止痛效果開始，即顯著的下降，但血中的二氧化碳仍維持在正常範圍。病人没有血壓過低或肌肉無力的現象，只有少數人有皮膚痒但皆不需要治療。第三有三位房人因爲疼痛需要其他的止痛劑，四組中並没有人發現有呼吸抑制的現象。因此，合併稀釋的Fentanyl與局部麻醉劑，作爲硬膜外點滴，不但可提供良好且平穩的止痛效果，而且可以減少麻藥的各種不良副作用，適合作爲手術後的止痛方式。