不同椎间隙穿刺留管术后硬膜外持续泵注低浓度罗哌卡因镇痛效应的比较

The analgesic effect of continuous infusion of ropivacaine with epidural catheter placed at different interspaces after gynecologic surgery

目的 研究妇科手术后不同椎间隙留管硬膜外持续泵注罗哌卡因镇痛效应。方法 选择经腹子宫全切术的病人80例(ASAⅠ-Ⅱ级)随机分为四组,A1、A2组术后硬膜外留管位置为T_(11-12);B1组、B2组则为L(2-3);均采用双泵镇痛法双盲对照观察(n=20)。四组第一泵为硬膜外0.2％罗哌卡因4ml/h;第二泵中A1组、B1组以0.08％氯诺昔康静脉病人自控镇痛(PCA)辅助,其PCA设置为0.8mg/次,锁定时间为5min;A2组与B2组以0.1％吗啡静脉PCA,其设置为1mg/次,锁定时间为5min。结果 四组24h硬膜外罗哌卡因使用剂量为192mg;A1组、A2组静脉氯诺昔康和吗啡PCA的剂量分别为(3.9±2.8)mg和(4.6±3.5)mg,而B1组、B2组则为(7.7±2.5)mg和(7.8±2.4)mg,T_(11-12)硬膜外留管(A1组、A2组)静脉辅助镇痛药量明显减少(P<0.05)。四组相同时间段内VAS、BCS、Bromage评分及D1/D2比值均无统计学差异。结论 妇科手术后T_(11-12)硬膜外留管0.2％罗哌卡因硬膜外持续泵注(4ml/h)比L_(2-3)留管的镇痛效应更强,且静脉PCA辅助药量更少。

Objective To assess the analgesic effect of continuous infusion of 0.2% ropivacaine with epidural catheter placed at T11-12 or L2-3 after abdominal hysterectomy. Methods Eighty ASA Ⅰ -Ⅱ patients undergoing elective abdominal hysterectomy were randomly divided into 4 groups with 20 patients in each group : in group Al and A2 the epidural catheter was placed at T11-12 and in group Bl and B2 at L2-3 . After surgery two infusion pumps were used. The first pump was used for continuous epidural infusion of 0.2% ropivacaine in the 4 groups. The second pump was used for patient controlled intravenous analgesia (PCIA) with 0.08% lornoxicam in group Al and Bl or with 0.1% morphine in group A2 and B2. The PCIA bolus dose was 1 ml with a lockout time of 5 min. The analgesic effect (assessed using VAS) and the consumption of lomoxicam / morphine were compared among the four groups. Results The ropivacaine consumption was 192 mg during the 24 h after operation in the 4 groups. The lornoxicam and morphine consumption were (3.9±2.8) mg and (4.6±3.5) mg in group Al and A2 with the epidural catheter placed at T11-12 and (7.7±2.5) mg and (7.8±2.4) mg in group B2 and B2 with catheter placed at L2-3.The consumption of lomoxicam or morphine was significantly less with epidural catheter placed at T11-12 than that with epidural catheter at L2-3 (P<0.05).There was no significant difference in VAS, Ramsay and Bromage scores among the 4 groups. Conclusion The analgesic effect of continuous epidural infusion of ropivacaine is better with the epidural catheter at T11-12 than that at L2-3.