Intrathecal fentanyl ／sufentanil enhance low-dosebupivacaine 椎管内芬太尼和舒芬
本帖最后由 shenxiu2 于 2009-12-25 10:36 编辑Intrathecal fentanyl or sufentanil enhance low-dose bupivacaine spinal block
The addition of fentanyl or sufentanil to low-dose diluted bupivacaine provides adequate anesthesia without hemodynamic instability for elderly men undergoing transurethral resection of the prostate (TURP), research shows.
These lipophilic opioids have a synergistic effect ensuring an adequate level of sensory block, with the added benefit of the limited distribution of the spinal block and a comparably rapid recovery provided by low-dose diluted bupivacaine, the research team explains.
Limiting the distribution of the block is important in TURP, as most patients are elderly and frequently present with cardiac, pulmonary, or other diseases.
H. K. Kil and colleagues from Yonsei University College of Medicine in Seoul, South Korea, randomly assigned 70 patients undergoing TURP to receive fentanyl 25 μg plus bupivacaine 0.5% (0.8 mL) plus normal saline 0.3 mL, or sufentanil 5 μg plus bupivacaine 0.5% (0.8 mL) plus normal saline 0.7 mL. Spinal anesthesia was successfully accomplished in all the patients. The peak sensory block level was significantly higher in the 35 patients receiving sufentanil than in the 35 patients receiving fentanyl, but no significant differences occurred in the time to peak block level, time to two-segment regression, and the degree of motor block. None of the patients had complete motor block.
After the operation, significantly more patients in the fentanyl group than in the sufentanil group needed analgesics, at 20 (57.1%) versus nine (25.7%). Fentanyl-treated patients also needed analgesics significantly sooner than sufentanil-treated patients, with the first request at 7.0 hours versus 10.6 hours, respectively.
However, the two groups did not differ with regard to the onset and recovery time of the sensory block, quality of anesthesia, and adverse effects.
The researchers conclude that supplementing low-dose diluted bupivacaine with either fentanyl or sufentanil provides adequate anesthesia without hemodynamic instability for TURP in elderly patients. But they add: “Sufentanil is superior to fentanyl, as it facilitates the spread of the block and offers greater postoperative analgesic efficacy.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009.
Kim SY, Cho JE, Hong JY, et al. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth 2009; 103: 750–754 阿片类药椎管内给药在提供镇痛的同时不会产生像用局麻药所伴有的交感和运动阻滞，镇痛效果优良，与局麻药有协和作用，可以减少局麻药的用量，适合用于小儿、老年、孕妇的特殊人群的手术。其作用机制为与G蛋白耦联的阿片受体结合，抑制腺苷酸循环，活化内流性钾通道、抑制电压门控性钙通道，从而降低作用部位神经元的兴奋性。虽有报道，芬太尼硬膜外给药与全身给药的并发症并无区别，包括皮肤瘙痒、尿潴留、恶心呕吐和过度镇静、呼吸抑制，只是发生率高低次序不同，前列者系硬膜外用药时，全身用药大体相反。阿片类药椎管内给药出现的皮肤瘙痒大多是一过性的，无需特殊处理。
页:
[1]