国产盐酸左旋布比卡因用于开胸术后硬膜外镇痛

Continuous epidural infusion of 0. 2 % levobupivacaine for relief of post thoracotomy pain

目的观察0．2％国产盐酸左旋布比卡因在开胸术后硬膜外持续泵注的镇痛效果,并与0．2％布比卡因进行比较。方法60例择期食管癌手术患者随机分为两组,每组30例:0．2％左旋布比卡因组(Lbup组)和0．2％布比卡因组(Bup组),镇痛液均含吗啡40μg／ml。全身麻醉诱导前行硬膜外置管,手术中间断注入1．6％利多卡因5 ml。术后采用患者自控镇痛。结果两组患者安静时镇痛效果均满意,咳嗽时伤口轻微疼痛,患者可以耐受,两组24 h内VAS评分在安静或咳嗽时差异均无统计学意义(P>0．05)。副作用少,未见严重并发症。结论0．2％国产盐酸左旋布比卡因复合吗啡用于胸科术后硬膜外镇痛同样有效,但较同浓度布比卡因更为安全、副作用少,其镇痛强度和同浓度的布比卡因相当。

Objective To investigate the analgesic efficacy and safety of continuous epidural infusion of 0. 2% levobupivacaine for patients with thoracotomy. Methods Sixty patients undergoing esophagogastrectomy were randomly divided into two groups： group Lbup （ n = 30 ） and group Bup （ n = 30 ）. A catheter was positioned at T（5-6） or T（6-7） epidural space before anesthesia induction. At the end of operation an infusion pump was connected to epidural catheter for continuous infusion of 0. 2% levobupivacaine or 0. 2% bupivacaine at a rate 5 ml·h^-1 （ plus morphine 200μg·h^-1 ）. Analgesic efficacy was evaluated with VAS （0 = no pain,10 =worst pain）. VAS and side effects were recorded at 2 h,4 h,8 h,12 h,24 h after operation. Results The analgesic efficacy of PCA was satisfactory in all patients. VAS had no significant difference between two groups（ P 〉 0. 05 ） during silence and coughing. No severe side effects were found. Conclusion Continuous epidural infusion of 0. 2% levobupivacaine was satisfactory and more safety for pain relief in patients post thoracotomy. 0. 2% levobupivacaine and 0. 2% bupivacaine have equal analgesic efficacy.