罗哌卡因复合奈福泮用于前列腺电切术病人术后硬膜外镇痛的效果观察
摘要
目的观察奈福泮复合罗哌卡因经硬膜外途径连续给药用于经尿道前列腺电切术患者术后的镇痛效果,以及奈福泮代替芬太尼用于老年患者经硬膜外途径术后镇痛的可行性和优缺点。
方法搜集山西医科大学第一医院收治的、接受经尿道前列腺电切手术的老年患者60例,要求无硬膜外麻醉禁忌症、无重要器官功能障碍、ASA分级I-II级、无近期服用镇静镇痛药、精神正常、能理解VAS等评分测试、愿意接受术后镇痛及能够配合试验。硬膜外麻醉失败,试验中硬膜外导管脱出,以及因其它原因无法观察试验数据者均予排除。
入选病例按照最小不平衡指数法分为三组:罗哌卡因组(R组)、罗哌卡因加芬太尼组(RF组)、罗哌卡因加奈福泮组(RN组)。手术前均施行连续硬膜外麻醉,取L2-3间隙,向头置管4cm,按常规进行麻醉管理。术毕即时给予硬膜外镇痛泵镇痛,R组镇痛液配方为罗哌卡因500mg加生理盐水至250ml,RF组镇痛液配方为罗哌卡因500mg加芬太尼0.5mg加生理盐水至250ml,RN组镇痛液配方为罗哌卡因500mg加奈福泮100mg加生理盐水至250ml。注射速度均为4ml/h。手术结束后即刻以及1,2,4,8,24,48小时观察记录患者疼痛视觉模拟评分、镇静Ramsay评分以及有无恶心呕吐、嗜睡、呼吸抑制、皮肤瘙痒等不良反应发生。
试验采用双盲法,由专人按照预先拟定的方案进行分组、配药并准确记录,由另一人进行术后数据采集。所有数据采集结束后再根据分组情况进行数据汇总分析。
结果罗哌卡因加奈福泮组(RN组)和罗哌卡因加芬太尼组(RF组)在各时点疼痛评分差异均无统计学意义(P>0.05),且在术后第2,4,8,24,48时点的疼痛评分均低于罗哌卡因组(R组),差异有统计学意义(P<0.05)。罗哌卡因加奈福泮组(RN组)和罗哌卡因组(R组)在各时点镇静评分差异无统计学意义(P>0.05),且和罗哌卡因加芬太尼组(RF组)在第4,8时点的镇静评分差异有统计学意义(P<0.05)。
结论奈福泮复合罗哌卡因经硬膜外途径连续给药用于经尿道前列腺电切术后的老年患者具有良好的镇痛效果,优于单纯使用罗哌卡因。
与使用芬太尼加局麻药相比,奈福泮加局麻药的镇痛效果相当但可能会减少过度镇静和呼吸抑制等不良反应,因此奈福泮代替芬太尼用于硬膜外术后镇痛更适合于老年人。
Objective To evaluate the postoperative analgesia efficacy of epidural ropivacaine plus nefopam in patients undergone transurethral resection of prostate.
Methods 60 cases ASA physical status I or II patients undergone transurethral resection of prostate with epidural anesthesia who requested postoperative analgesia were assigned to one of three groups according to minimization methods: ropivacaine plus nefopam group, ropivacaine plus fentanyl group and ropivacaine group. The ropivacaine plus nefopam group received a postoperative analgesia with epidural 0.2% ropivacaine plus nefopam 0.4mg/ml. The ropivacaine plus fentanyl group received a postoperative analgesia with epidural 0.2% ropivacaine plus fentanyl 2μg/ml. The ropivavaine group received a postoperative analgesia with epidural 0.2% ropivacaine. The intensity of pain, the intensity of sedation, and the side effects were recorded with double-blind method.
Results The three groups were comparable in regard to age, height, body weight and minutes of operation. Three were no significant differences in VAS score between the ropivacaine plus nefopam group and the ropivacaine plus fentanyl group, but patients in the two groups both had lower VAS scores at 2,4,8,24 and 48 hours than those in ropivacaine group. RSS scores were higher in the ropivacine plus nefopam group than in ropivacaine plus fentanyl group at 4 and 8 hours. There were no significant differences in the adverse between the three groups.
Conclusion Epidural analgesia with 0.2% ropivacaine plus nefopam 0.4mg/ml provides excellent postoperative analgesia effect for patients undergone transurethral resection of prostate.
方法搜集山西医科大学第一医院收治的、接受经尿道前列腺电切手术的老年患者60例,要求无硬膜外麻醉禁忌症、无重要器官功能障碍、ASA分级I-II级、无近期服用镇静镇痛药、精神正常、能理解VAS等评分测试、愿意接受术后镇痛及能够配合试验。硬膜外麻醉失败,试验中硬膜外导管脱出,以及因其它原因无法观察试验数据者均予排除。
入选病例按照最小不平衡指数法分为三组:罗哌卡因组(R组)、罗哌卡因加芬太尼组(RF组)、罗哌卡因加奈福泮组(RN组)。手术前均施行连续硬膜外麻醉,取L2-3间隙,向头置管4cm,按常规进行麻醉管理。术毕即时给予硬膜外镇痛泵镇痛,R组镇痛液配方为罗哌卡因500mg加生理盐水至250ml,RF组镇痛液配方为罗哌卡因500mg加芬太尼0.5mg加生理盐水至250ml,RN组镇痛液配方为罗哌卡因500mg加奈福泮100mg加生理盐水至250ml。注射速度均为4ml/h。手术结束后即刻以及1,2,4,8,24,48小时观察记录患者疼痛视觉模拟评分、镇静Ramsay评分以及有无恶心呕吐、嗜睡、呼吸抑制、皮肤瘙痒等不良反应发生。
试验采用双盲法,由专人按照预先拟定的方案进行分组、配药并准确记录,由另一人进行术后数据采集。所有数据采集结束后再根据分组情况进行数据汇总分析。
结果罗哌卡因加奈福泮组(RN组)和罗哌卡因加芬太尼组(RF组)在各时点疼痛评分差异均无统计学意义(P>0.05),且在术后第2,4,8,24,48时点的疼痛评分均低于罗哌卡因组(R组),差异有统计学意义(P<0.05)。罗哌卡因加奈福泮组(RN组)和罗哌卡因组(R组)在各时点镇静评分差异无统计学意义(P>0.05),且和罗哌卡因加芬太尼组(RF组)在第4,8时点的镇静评分差异有统计学意义(P<0.05)。
结论奈福泮复合罗哌卡因经硬膜外途径连续给药用于经尿道前列腺电切术后的老年患者具有良好的镇痛效果,优于单纯使用罗哌卡因。
与使用芬太尼加局麻药相比,奈福泮加局麻药的镇痛效果相当但可能会减少过度镇静和呼吸抑制等不良反应,因此奈福泮代替芬太尼用于硬膜外术后镇痛更适合于老年人。
Objective To evaluate the postoperative analgesia efficacy of epidural ropivacaine plus nefopam in patients undergone transurethral resection of prostate.
Methods 60 cases ASA physical status I or II patients undergone transurethral resection of prostate with epidural anesthesia who requested postoperative analgesia were assigned to one of three groups according to minimization methods: ropivacaine plus nefopam group, ropivacaine plus fentanyl group and ropivacaine group. The ropivacaine plus nefopam group received a postoperative analgesia with epidural 0.2% ropivacaine plus nefopam 0.4mg/ml. The ropivacaine plus fentanyl group received a postoperative analgesia with epidural 0.2% ropivacaine plus fentanyl 2μg/ml. The ropivavaine group received a postoperative analgesia with epidural 0.2% ropivacaine. The intensity of pain, the intensity of sedation, and the side effects were recorded with double-blind method.
Results The three groups were comparable in regard to age, height, body weight and minutes of operation. Three were no significant differences in VAS score between the ropivacaine plus nefopam group and the ropivacaine plus fentanyl group, but patients in the two groups both had lower VAS scores at 2,4,8,24 and 48 hours than those in ropivacaine group. RSS scores were higher in the ropivacine plus nefopam group than in ropivacaine plus fentanyl group at 4 and 8 hours. There were no significant differences in the adverse between the three groups.
Conclusion Epidural analgesia with 0.2% ropivacaine plus nefopam 0.4mg/ml provides excellent postoperative analgesia effect for patients undergone transurethral resection of prostate.
引文
[1] Sunshine A, Laska E. Nefopam and morphine in man. Cliniclal Pharmacology Ther, 1975,18:530-534
[2] Gasser JC, Bellville JW. Respiratory effects of nefopam. Clinical Pharmacology Ther, 1975,18:175-179
[3]赵煜毅,田新民.盐酸奈福泮在硬膜外术后镇痛中的应用.临床麻醉学杂志,2004,20(5):182-183
[4] Kapfer B, Alfonsi P, Guigrard B, et al. Nefopam and ketamine comparably enhance postoperation analgesia. Anesthesia & Analgesia, 2005 Jan,100(1):169-174
[5] Rosland JH, Hole K. The effect of nefopam and its enantiomers on the uptake of 5-hydroxytryptamine,noradrenaline and dopamine in crude rat brain synaptosomal preparations.J pharm pharmacol,1990 Jun,42(6):437-8
[6] Fuller RW,Snoddy HD.Evaluation of nefopam as a monoamine uptake inhibitor in vivo in mice.Neuropharmacology,1993 Oct,32(10):995-9
[7] Verleye M, Andre N, Heulard I, et al. Nefopam blocks voltage-sensitive sodium channels and modulates glutamatergic transmission in rodents.Brain Res,2004 Jul ,1013(2):249-55
[8] Novelli A, Diaz-Trelles R, Groppetti A, et al.Nefopam inhibits calcium influx,cGMP formation, and NMDA receptor-dependent neurotoxicity following activation of voltage sensitive calcium channels. Amino Acids,2005 Mar, 28(2):183-91
[9]王本琼,张晓波,谢志光.留置硬膜外导管在老年前列腺术后镇痛中的应用.中国现代医学杂志,2003,13(11):125-125,127
[10] Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiolog, 2000 Feb,92(2):433-41
[11] Coda BA, Brown MC, Schaffer R, et al. Pharmacology of epidural fentanyl, alfentanil, and sufentanil in volunteers. Anesthesiology, 1994 Nov,81(5):1149-61
[12]张世娟等译,Ronald Kanner主编.美国最新临床医学问答---疼痛治疗.北京:海洋出版社/香港:科文出版有限公司,2003.254
[13]张承业,王静,詹新,等.临床药理实验新方法---序贯平衡系数法.中国药理学通报,2005,21(12):1524-5
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[2] Gasser JC, Bellville JW. Respiratory effects of nefopam. Clinical Pharmacology Ther, 1975,18:175-179
[3]赵煜毅,田新民.盐酸奈福泮在硬膜外术后镇痛中的应用.临床麻醉学杂志,2004,20(5):182-183
[4] Kapfer B, Alfonsi P, Guigrard B, et al. Nefopam and ketamine comparably enhance postoperation analgesia. Anesthesia & Analgesia, 2005 Jan,100(1):169-174
[5] Rosland JH, Hole K. The effect of nefopam and its enantiomers on the uptake of 5-hydroxytryptamine,noradrenaline and dopamine in crude rat brain synaptosomal preparations.J pharm pharmacol,1990 Jun,42(6):437-8
[6] Fuller RW,Snoddy HD.Evaluation of nefopam as a monoamine uptake inhibitor in vivo in mice.Neuropharmacology,1993 Oct,32(10):995-9
[7] Verleye M, Andre N, Heulard I, et al. Nefopam blocks voltage-sensitive sodium channels and modulates glutamatergic transmission in rodents.Brain Res,2004 Jul ,1013(2):249-55
[8] Novelli A, Diaz-Trelles R, Groppetti A, et al.Nefopam inhibits calcium influx,cGMP formation, and NMDA receptor-dependent neurotoxicity following activation of voltage sensitive calcium channels. Amino Acids,2005 Mar, 28(2):183-91
[9]王本琼,张晓波,谢志光.留置硬膜外导管在老年前列腺术后镇痛中的应用.中国现代医学杂志,2003,13(11):125-125,127
[10] Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiolog, 2000 Feb,92(2):433-41
[11] Coda BA, Brown MC, Schaffer R, et al. Pharmacology of epidural fentanyl, alfentanil, and sufentanil in volunteers. Anesthesiology, 1994 Nov,81(5):1149-61
[12]张世娟等译,Ronald Kanner主编.美国最新临床医学问答---疼痛治疗.北京:海洋出版社/香港:科文出版有限公司,2003.254
[13]张承业,王静,詹新,等.临床药理实验新方法---序贯平衡系数法.中国药理学通报,2005,21(12):1524-5
[1] Reynolds F,Sharma SK,Seed PT. Analgesia in labour and fetal acid-base balance:a meta-analysis comparing epidural with systemic opioid analgesia [J].BJOG,2002,109(12):1344
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