舒芬太尼、芬太尼和瑞芬太尼预防异丙酚注射痛的应用探讨

Effects of sufentanil, fentanil, and remifentanil on preventing propofol injection pain

目的研究不同阿片类药物舒芬太尼、芬太尼、瑞芬太尼对异丙酚注射痛的影响。方法择期手术患者250例，ASAⅠ—Ⅱ，按随机、对照、双盲法均分为五组：空白对照组（0．9％氯化钠注射液3ml，n=50）、舒芬太尼组（10μg，n=50）、芬太尼组（100μg，n=50）、瑞芬太尼组（15μg，n=50）和2％利多卡因组（3ml，n=50），所研究的阿片类药物均稀释成3ml溶液。研究药物注入外周静脉后1min后以0．5ml／min的速度注射异丙酚（1％得普利麻）50mg。立即观察和询问注射处有无疼痛，并进行评估。结果利多卡因组、舒芬太尼组、瑞芬太尼组和芬太尼组都显著降低了异丙酚的注射痛（Χ^2分别=38．45、18．53、12、73和12．73，P均〈0．05）。但阿片类药物的明显有一副作用为咳嗽，同时阿片类药物减轻异丙酚注射痛的有效性不如利多卡因组（Χ^2=8．73，P〈0．05）。所研究的4种药物有效性为利多卡因〉舒芬太尼〉瑞芬太尼〉芬太尼。结论三种阿片类药物都显著的降低了异丙酚的注射痛．阿片类药物除了中枢的镇痛作用外在外周可能有直接的局麻作用。

Objective To compare the efficacy of sufentanil, fentanil, and remifentanil in minimizing pain caused by injection of propofol. Methods We undertook a randomized, placebo - controlled, double - blind study in 250 patients. The patients were given saline（3 ml, n = 50）, sufentanil（ 10μg, n = 50）, fentanil（ 100 mg, n = 50）, remifentanil （20μg, n = 50）, or 2% lidocaine （60 mg, n = 50） diluted into a 3 ml solution. The venous retention of the drugs was maintained for 1 min, and then IV administration of propofo150 mg in 10 s. Pain assessments were made immediately after the propofol injection. Results Lidocaine, sufentanil, remifentanil and fentanil all significantly reduced propofol injection pain more than placebo （Χ^2= 38.45, 18.53,12.73 and 12.73 respectively ,P 〈 0.01）, but there were more side effects in the opioid drug groups especially cough. Lidocaine had better effect than opioids to reduce propofol injection pain （ Χ^2 = 8.73, P 〈 0.05 ）. The order of efficacy was lidocaine 〉 sufentanil 〉 remifentanil 〉 fentanil. Conclusions Sufentanil, fentanil, and remifentanil can reduce propofol injection pain obviously. The peripheral analgesic effects of these opioids are due to their local anesthetic activity.