- 期刊
Ropivacaine 0.1% with or without fentanyl for Epidural Postoperative Analgesia: A Randomized, Double-Blind Comparison
單獨使用ropivacaine與ropivacaine合併fentanyl兩者應用於病患自控式硬膜外止痛法的止痛效果之比較
摘要
背景：硬膜外注射止痛被視為是最有效之止痛方式。Ropivacaine是一種最新的局部麻醉藥，其毒性卻比同類之bupivacaine低。如能降低麻醉藥之濃度，相對其毒性及副作用也隨之下降。因此，在使用硬膜外注射之止痛方法時，常會合併使用局部麻醉藥與鴉片類藥物，進而達到最有效之止痛效果及降低其副作用。方法：本實驗分作兩組，每組病人各105名。各組使用之藥物分別是：R組為0.1% ropivacaine，RF組為0.1% ropivacaine與1微克fentanyl。病人於術後開始使用，並於0 min、30 min、1h、3h、6h、12h、24h記錄其VAS、Bromage分數及其副作用等。結果：兩組的基本資料無顯著差異。在止痛效果方面，RF組比R組優越。而副作用方面，兩者無明顯之差異。結論：使用低劑量鴉片類藥物合併局部麻醉藥，確實能在止痛方面有良好之效果。不但能同時降低使用之局部麻醉藥濃度，相對其副作用也能隨之減少。
關鍵字
硬膜外止痛並列摘要
Epidural analgesia is often considered optimal postoperative analgesia for certain surgical procedures. Ropivacaine is a new local anesthetic that is less toxic than its homologue, bupivacaine. Epidural infusions usually comprise a local anesthetic, an opioid, or a combination of the two to improve analgesic efficacy and reduce unwanted side effects. All 210 patients undergoing lower abdominal or lower extremity surgery received epidural analgesia infusions at 7 mL/hour, 105 with 0.1% ropivacaine and 105 with 0.1% ropivacaine plus 1μg/mL fentanyl. Pain score and side effects (hypotension, nausea, vomiting, pruritus, paresthesia, urinary retention and motor block) were measured at 0, 0.5, 1, 3, 6, 12, and 24 hours. There was no statistical difference in patient profile between the groups. Pain relief scores were similar in the two groups in the first hour after the drugs were given. However, pain relief was significantly better in the ropivacaine/fentanyl group after the first hour and this difference lasted for the remaining time. There was no significant difference in adverse events between the two groups during 24 hours of assessment. In conclusion, the quality of analgesia was significantly improved by the addition of fentanyl 1μg/mL to ropivacaine.