The effect of sufentanil on the minimum local analgesic concentration of epidural lidocaine
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摘要: 目的 比较不同剂量舒芬太尼对成人腰段硬膜外利多卡因最低局麻药镇痛浓度(MLAC)的影响。 方法 选择择期行泌尿科及肛肠科手术患者90例,ASA Ⅰ级或Ⅱ级,年龄32~63岁,随机分为3组(n=30):L组(单纯利多卡因)、LSF1组(利多卡因＋10 μg舒芬太尼)、LSF2组(利多卡因＋20 μg舒芬太尼)。首例均用1%利多卡因20 ml,其后根据前一例患者的VAS评分,按照序贯增减法依次变动利多卡因的浓度,浓度变化梯度0.1%,观察30 min后痛觉阻滞的程度(VAS≤1为有效),下肢运动阻滞的Bromage分级。根据Dixon和Massey法计算3组利多卡因的MLAC及95%可信区间(CI)。 结果 LSF1组利多卡因用于成年人腰段硬膜外的MLAC为0.590%(95%CI为0.537%~0.660%),LSF2组的MLAC为0.382%(95%CI为0.329%~0.446%),均显著低于L组的MLAC 0.781%(95%CI为0.728%~0.844%)(P<0.01)。在镇痛有效的病例中,LSF2组Bromage分级显著低于L组和LSF1组。 结论 硬膜外利多卡因复合10及20 μg舒芬太尼均能显著减少利多卡因的最低局麻药镇痛浓度,且无明显不良反应,硬膜外利多卡因复合20 μg舒芬太尼在达到同等镇痛效果时,还能显著减轻下肢运动神经的阻滞。20 μg舒芬太尼可能是最佳的复合剂量。Abstract: Objective To compare the effect of different dosage of sulfentanil on the minimum local analgesic concentration of epidural licocaine. Methods 90 patients with urology and anorectic surgery, ASA Ⅰ or Ⅱ, 32-63 years, were randomly divided into 3 groups (n=30):L group (only lidocaine), LSF1 group (lidocaine +10 μg sufentanil) and LSF2 group (lidocaine +20 μg sufentanil). First case of patient in each group was given 20 ml of 1% lidocaine, thereafter in accordance with VAS score of the patient, the lidocaine was given by in turn decrease method according to the sequential changes in the concentration of lidocaine. The concentration gradient was 0.1%, and block pain degree was observed after 30 minutes (VAS ≤ 1 is valid), lower limb motor block Bromage classification was observed. MLAC and 95% confidence intervals(CI) of lidocaine in 3 groups was calculated according to Dixon and Massey. Results MLAC of lidocaine on adult lumbar epidural in LSF1 group was 0.590% (95%CI 0.537%-0.660%), MLAC in LSF2 group was 0.382% (95%CI 0.329%-0.446%), and MLAC of both groups were significantly lower than L group 0.781% (95%CI 0.728%-0.844%) (P<0.01). In effective analgesia cases, Bromage grade of LSF2 group was significantly lower than that of L and LSF1 group. Conclusion Epidural lidocaine combined with 10 and 20 μg sufentanil could significantly reduce local anesthetic effect of the minimum analgesic concentration of lidocaine, and no significant adverse reactions. Epidural lidocaine combined with 20 μg sufentanil reached the same analgesic effect, and significantly reduce the lower extremity motor nerve block. So 20 μg sufentanil might be the best combined dose.
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Key words:
- sufentanil /
- lidocaine /
- epidural anesthesia /
- the minimum local analgesic concentration
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