罗哌卡因用于病人自控上胸段硬膜外镇痛

Application of Ropivacaine in patients to control upper thoracic epidural analgesia

目的比较0.15%、0.20%和0.25%的罗哌卡因加2μg/mL芬太尼用于乳癌术后病人自控硬膜外镇痛(PCEA)的效果及不良反应。方法60例ASAⅠ～Ⅲ级择期乳癌根治术的病人,T2～3或T3～4常规硬膜外穿刺向头端置管,注入1.00%利多卡因3mL为试验量,5min后分别以0.15%(Ⅰ组n=20)、0.20%(Ⅱ组n=20)和0.25%(Ⅲ组n=20)的罗哌卡因加2μg/mL芬太尼维持麻醉并继续行术后PCEA,持续镇痛治疗48h,由不知情者记录术后0￣3,3￣24,24￣48h各时段休息和咳嗽时的VAS评分,不良反应及呼吸频率、潮气量和分钟通气量。结果3组病人均未出现严重的并发症。组Ⅱ与组ⅢVAS评分比较差异无显著性(P>0.05),组Ⅰ与组ⅡVAS评分比较术后24h内差异均有显著性(P<0.05),呼吸频率、潮气量和分钟通气量3组各时点比较差异无显著性。结论0.20%和0.25%的罗哌卡因加2μg/mL芬太尼可满意而安全地用于乳腺癌根治手术后上胸段PCEA。

[Objective] To compare the effect and side-effect of 0.15%, 0.20% and 0.25% Ropivacaine with 2 μg/mL Fentanyl for patients to control upper thoracic epidural analgesia after undergoing selective radical mastectomy. [Methods] Sixty ASA Ⅰ-Ⅱ patients were anesthetized with upper thoracic epidural block. T2-3 or T3-4 were selected as puncture site. A catheter was inserted into the epidural space in a cephalad directed for 3, 4 cm. A loading dose of 0.15%（group Ⅰ n=20）, 0.20%（group Ⅱ n=20 and 0.25% （group Ⅲn=20） ropivacaine with 2 μg/mL Fentanyl was given after a test dose of 1.00% Lidocaine 3 mL and continuously used it for PCEA 48 hours after operation. Dynamic visual analogue pain scale（VAS） during rect or coughing, side effect, meanwhile the breathing frequency, minute ventilation, and tidal volume were monitored within two postoperative days. [Results] There were no side effects recorded in all patients. There was no significantly different for VAS between group Ⅱ and group Ⅲ （P 〉 0.05）, but higher in group Ⅰ （P 〈0.05） on first day after surgery. [Conclusions] Either 0.20% or 0.25% Ropivacaine with 2 μg/mL Fentanyl can provide satisfactory postoperative PCEA for patients undergoing selective radical mastectomy.