罗哌卡因联合舒芬太尼用于全膝关节置换术后硬膜外镇痛效果观察

Randomized controlled trial of patient-controlled epidural analgesia after total knee arthroplasty with ropivacaine and sufentanil

目的:探讨舒芬太尼联合罗哌卡因在全膝关节置换(TKA)术后患者自控硬膜外镇痛的效果观察。方法:选择80例ASAI^II级全膝关节置换术后患者,随机分为4组,L组、S1组、S2组、S3组,实施患者自控硬膜外镇痛(PCEA),L组为0.1%罗哌卡因50 ml,S1组为0.1%罗哌卡因50 ml(含舒芬太尼0.25μg/ml),S2组为0.1%罗哌卡因50 ml(含舒芬太尼0.5μg/ml),S3组为0.1%罗哌卡因50 ml(含舒芬太尼0.75μg/ml),观察并记录术后1 h、6 h、12 h、24 h休息与被动运动的视觉模拟评分(VAS),同时记录低血压、恶心/呕吐、瘙痒等不良反应。结果:术后休息与被动运动的疼痛评分(VAS)均<2.5。术后瘙痒的发生率S1组明显低于S2组、S3组。结论:S1组(0.1%罗哌卡因+舒芬太尼0.25μg/ml)术后瘙痒的发生率明显降低。因此,TKA术后PCEA镇痛的最适剂量为舒芬太尼0.25μg/ml。

Objective To investigate the effects sufentanil in total knee arthroplasty（ TKA）. Method Eighty patients scheduled for TKA were enrolled for the study. Seventy-one patients（ ASA physical status Ⅰ -Ⅱ） were randomly allocated into four groups： group L,group S1,group S2 and group S3. All groups received 0. 1% ropivacaine through PCEA and three of these groups received sufentanil（ group S1： sufentanil 0. 25 μg / ml,group S2： sufentanil 0. 5 μg / ml,and group S3： sufentanil 0. 75 μg / ml）. Postoperative pain scores were evaluated using VAS（ visual analog scale,0 -10） and side effects such as hypotension,nausea / vomiting,pruritus were evaluated at 1,6,12,24 hours after PCEA started. Results Postoperative pain scores at rest and on mobilization were 2. 5 at all times which we considered to represent satisfactory pain management. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. Conclusion The incidence of side effects were significantly lower in group S1（ 0. 1% ropivacaine plus sufentanil 0. 25 μg / ml）. Therefore,0. 25 μg / ml of sufentanil through PCEA is the recommended dose for postoperative pain control in TKA.