下肢骨科手术后硬膜外隙应用舒芬太尼复合左旋布比卡因镇痛效果的探讨

Investigation into Antalgic Outcome of Sufentanil plus Levobupivacaine Injected into Epidural Space after Orthopedic Operation in Lower Limbs

目的评价舒芬太尼(Sfen)复合左旋布比卡因(L-Bup)硬膜外隙注射术后镇痛的效应。方法选择下肢骨科手术病人46例,随机分成S组(23例)和M组(23例)。两组均行L2～3硬膜外隙穿刺术并头向置管4 cm,S组硬膜外隙注射Sfen 20μg+0.5%L-Bup 5 ml,M组注入吗啡(Mor)2 mg+0.5%L-Bup 5 ml,术后两组均行硬膜外自控镇痛(PCEA),其配方S组为0.225%L-Bup+Sfen 60μg+氟派利多3 mg,M组为0.225%L-Bup+Mor5 mg+氟派利多3 mg,负荷量5 ml,持续背景输注量2 ml,单次PCA量1 ml,锁定时间15 min。结果镇痛满意率(VAS≤3)S组95.65%,M组86.96%两组比较差异有统计学意义(P<0.05),尿潴留、恶心呕吐、皮肤瘙痒等副作用S组均低于M组。结论Sfen复合L-Bup硬膜外术后镇痛效果满意,副作用少。

Objective To evaluate the antalgic outcome of sufentanil plus levobupivacaine injected into epidural space. Methods A total of 46 patients who would undergo orthopedic operation in their lower limbs were randomized into Group S （n = 23） and Group M （ n = 23）. Puncture into epidural space was made via L2 - 3 and tube was inserted by 4 cm in tile direction of the heads in both the groups. Group S was injected with sufcntanil （20 μg） plus levobupivacaine （5% , 5 ml） , and Croup M with morphine （2 mg） plus levobupivacaine （5%o, 5 ml）. Postoperative patient-controlled epidural anesthesia C PCEA） was administered to all the patients. The PCEA mixt,re consisted of sufentanil （60 μg） , levobupivacaine （225 mg） and droperidol （3 mg） for Group S, and of levobupivacaine （225 mg） , morphine （5 mg） and droperidol （3 mg） for Group M with a load dosage of 5 ml, a continous background infusion of 2 ml, a single patient-controlled anesthesia of 1 ml and a lockout time of 15 minutes. Results The rate ot satisfactory analgesia[ visual analog scale （VAS） ≤3 ] was 95.65% in Group S and 86.96% in Croup M, between which there was a significant difference （P 〈 0.05 ）. Additionally, Group S took the advantage over Croup M in decreasing the adverse reactions such as urine retention, nausea and vomiting, and itch. Conclusion It is indicated that sufentanil plus levobupivacaine brings about a satisfactory antalgic outcome, in addition to fewer adverse reactions, when applied to operative epidural anesthesia.