鞘内注射新斯的明用于术后镇痛的临床研究

Efficacy of intrathecal neostigmine in postoperative analgesia

目的 探讨鞘内注射不同剂量新斯的明的术后镇痛效果及不良反应。方法 4 0例择期在腰麻下行下肢手术的患者 ,随机分为A、B、C、D四组 ,每组 10例。均在L3～ 4间隙穿刺 ,蛛网膜下隙注入 0 .5 %布比卡因3ml,然后每组分别再注入生理盐水 0 .3ml、0 .0 5 %新斯的明 0 .1ml+0 .2ml生理盐水、0 .0 5 %新斯的明 0 .2ml+生理盐水 0 .1ml、0 .0 5 %新斯的明 0 .3ml。观察麻醉效果、不良反应、术后疼痛程度及镇痛剂使用情况。结果 各组最高痛觉消失平面及其所需时间的差异无显著性。与A组相比 ,B、C、D组的视觉模拟评分法 (VAS)明显降低 (P <0 .0 5 ) ,切口疼痛出现时间明显延长 (P <0 .0 1) ;B、C、D三组间差异无显著性 ;D组术后呕吐发生率明显升高 (P <0 .0 5 )。结论 鞘内注射新斯的明 5 0～ 15 0 μg术后镇痛安全有效 ,但 15 0 μg时不良反应的发生率较高 ,故应以 5 0～ 15 0 μg为宜。

Objective To appraise the efficacy of intrathecal neostigmine(N) in postoperative analgesia. Methods 40 patients undergoing lower extremity operation were randomly divided intoA,B,C,D groups.After 3ml bupivacaine(0.5%) was injected intrathecally,then, 0.09% NaCl 0.3ml, 0.05% N 0.1 ml+0.09% NaCl 0.2 ml, 0.05%N 0.2 ml +0.09% NaCl 0.1 ml and 0.05%N 0.3 ml was administered intrathecally in each respective group.The efficacy of anesthesia and postoperative analgesia were observed.Results Compared with A group, VAS of patients in group B、C、D decreased(P<0.05),the postoperative pain of incisional wound also delayed (P<0.01).The frequency of emesis in group D was higher than that in group A (P<0.05).Conclusion Intrathecal neostigmine(50-100 μg) in postoperative analgesia is effective and safe.The frequency of emesis is higher at the dosage of 150μg.