【 摘 要 】
Aim: Optimum pain relief after thoracotomy is essential to reduce atelectasis and postoperative pneumonias. The aimof this prospective, double blind, randomised controlled trial was to compare the analgesic and adverse effects of threeconcentrations of fentanyl with 0.2% ropivacaine in thoracic epidural in patients undergoing thoracotomy andthoracomyolpasty.Methodology: After getting approval from Ethical Committee, this study was performed in 60 patients of either sex,aged 18-60 years, American Society of Anaesthesiology (ASA) grade I to III. Informed consent was taken from all ofthe patients, who were recruited and divided into three groups of 20 patients in each group. Patients scheduled forelective thoracotomy surgery were enrolled in the study. Patients with preexisting motor and sensory deficit, addictedto hypnosedative drugs, on chronic opioid or analgesic therapy, sensitive to local anaesthetic or study medication, orhaving contraindications to regional anesthesia were excluded from this study. In patients, with whom communicationdifficulties prevented reliable assessment, were also excluded.Patients received either 2.5μg/ml (Group I), 5.0μg/ml (Group II) or 7.5μg/ml of fentanyl (Group III) respectively, withropivacaine 0.2% via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation was assessedusing a visual analogue scale (VAS) and observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Sedation scoreswere also noted. Adverse effects were simultaneously assessed.Results: There was no significant difference in the baseline characteristics between the three groups. The number ofpatients with episodes of unsatisfactory pain relief, i.e. a VAS scores >40 and OVRS >2, at each of the four assessmentspostoperatively, was higher in Group I than with Group II or Group III (p 3 compared with one (5%) in Group II. No patient in Group I had a sedation score >3 (p <0.05). In addition, all patients experienced pruritus in Group I compared with 10% and 5% in Group II and Group Irespectively. 30% of the patients had emetic symptoms in Group III, compared to 20% and 5% in Group II and GroupI respectively (p < 05).Conclusion: We conclude that a thoracic epidural bolus of 10 ml ropivacaine 0.2% with fentanyl 5.0 μg/ml providesthe optimal balance between pain relief and sedation.
【 授权许可】
CC BY|CC BY-ND|CC BY-NC|CC BY-NC-ND
【 预 览 】
Files | Size | Format | View |
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RO202107100003426ZK.pdf | 381KB | download |