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上腹部開腹術後の硬膜外腔持続鎮痛法で用いるフェンタ Titleニル併用ロピバカインの注入速度が術後鎮痛効果に及ぼす影響 Author(s) 梅村, 直治 ; 小板橋, 俊哉 Journal 臨床麻酔, 32(2): 185-190 URL http://hdl.handle.net/10130/593 この資料は梅村直治, 小板橋俊哉.

1 上腹部開腹術後の硬膜外腔持続鎮痛法で用いるフェンタ Titleニル併用ロピバカインの注入速度が術後鎮痛効果に及ぼす影響 Author(s) 梅村, 直治 ; 小板橋, 俊哉 Journal 臨床麻酔, 32(2): URL この資料は梅村直治, 小板橋俊哉. 上腹部開腹術後の硬膜外腔持続鎮痛法で用いるフェンタニル併用ロピバカインの Right 注入速度が術後鎮痛効果に及ぼす影響. 臨床麻酔 32 巻 2 号 Page ( ) にて出版された論文の著版原稿である Posted at the Institutional Resources for Unique Colle Available from

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3 ml/hr 4ml/hr 6.7 g/kg/day 4ml / hr g/ml 2ml / hr g/ml VAS mm 24 4ml/hr 4 2ml/hr 5 4ml/hr 2

4 3

5 VAS ml/hr 4

6 PCEA PCEA 2ml/h 4ml/h 20 ASA mg 0.5mg 1 2mg 7 8 5

7 ml 3 5 ml F- 45 F- 33 F- 6.7 g/kg/day g/ml 0.2 2ml/hr F- 6.7 g/kg/day g/ml 0.2 4ml/hr mg 100mm visual 6

8 analogue scale VAS Fisher Mann-Whitney U Kruskal-Wallis P < 0.05 VAS F-2 F Table 7

9 Fig. 1, 2 1 VAS VAS VAS F-4 20mm F-2 30mm F-2 F-4 P = 0.035, F-2 F F-4 F F-4 F

10 ml/hr 4ml/hr F-4 F VAS 10 45mm 20mm F-2 1 9

11 0.2 5ml / hr 2ml / hr VAS 30 70mm mm VAS 25mm 4 50mm VAS VAS F mm 10

12 F-2 60mm 0.2 4ml / hr 2ml / hr

13 Turner ml / hr ml / hr 8 ml / hr cm 6 ml / hr 155cm 4 6 ml / hr 9 patient-control epidural analgesia (PCEA) 12

14 cm VAS F-4 20mm 40mm 4 ml / hr

15 g / kg / hr g / hr 14 Scott g / hr 40 g / hr 40 g / hr Whiteside g / hr VAS 40mm 15 8 g / hr VAS 45mm F-2 F-4 16 g / hr 14

16 F-2 F ml / hr L2 L2 T7-9 15

17 4ml / hr 2ml / hr 16

18 1) ) Scott DA, Chamley DM, Mooney PH, et al : Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery a dose finding study. Anesth Analg 1995 ; 81 : ) Whiteside R, Jones D, Bignell S, et al : Epidural ropivacaine with fentanyl following major gynaecological surgery: the effect of volume and concentration on pain relief and motor impairment. Br J Anaesth 2000 ; 84 : ) Scott DA, Blake D, Buckland A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/ml fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg 1999 ; 88 : )., Q&A.,, ) Feldman HS, Arthur GR, Covino BG : Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and

19 lidocaine in the conscious dog. Anesth Analg 1989 ; 69 : ) Scott DB, Lee A, Fagan D, et al : Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989 ; 69 : ) Turner G, Blake D, Buckland D, et al : Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. Br J Anaesth 1996 ; 76 : ) NA ) ) Hjortso NC, Lund C, Mogensen T, et al : Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery. Anesth Analg 1986 ; 65 : ) White MJ, Berghausen EJ, Dumont SW, et al : Side effects during continuous epidural infusion of morphine and fentanyl. Can J Anaesth 1992 ; 39 :

20 13) Vallejo MC, Edwards RP, Shannon KT, et al : Improved bowel function after gynecological surgery with epidural bupivacaine-fentanyl than bupivacaine-morphine infusion. Can J Anaesth 2000 ; 47 : ) Oscar A, de Leon-Casasola, Mark J : Postoperative epidural opioid analgesia : What are the choices? Anesth Analg 1996 ; 83 : ) PCEA ) Apfel CC, Laara E, Koivuranta M, et al : A simplified risk score for predicting postoperative nausea and vomiting. Conclusions from cross-validations between two centers. Anesthesiology 1999 ; 91 :

21 Table Demographic Data Group F-2 Group F-4 P ( n = 40 ) ( n = 30 ) Gender ( M ) NS 1) Gender ( F ) Age ( yr ) 64±11 66±9 NS 2) Height ( cm ) 160±9 157±15 NS 2) Weight ( kg ) 58±11 56±13 NS 2) Data are expressed as mean SD. Group F-4 : patients received epidural ropivacaine 0.2% + fentanyl 6.7 g/kg/day at 4mL/h. Group F-2 : patients received epidural ropivacaine 0.2% + fentanyl 6.7 g/kg/day at 2mL/h 1) Fisher s exact probability test. 2) Mann-Whitney s U test.

22 100 VAS Score (mm) Group F-4 Group F hr 24 hr 48 hr Time after surgery ( hours ) Fig. 1 Visual analogue scale (VAS) score for pain at rest. Group F-4 : patients received epidural ropivacaine 0.2% + fentanyl 6.7 g/kg/day at 4mL/h. Group F-2 : patients received epidural ropivacaine 0.2% + fentanyl 6.7 g/kg/day at 2mL/h. Box plots show the interquartile range with median values joined by a line. There were no statistical differences between the groups.

23 VAS Score (mm) Group F-4 Group F * * hr 24 hr 48 hr Time after surgery ( hours ) Fig. 2 Visual analogue scale (VAS) scores for pain during mobilization. Group F-4, Group F-2 : See the legend in Fig. 1. Box plots show the interquartile range with median values joined by a line. *P < 0.05 compared to Group F-2.

24 A Comparison of the Infusion Rate (2ml/hr and 4ml/hr) of 0.2% Ropivacaine Combined with Fentanyl for Postoperative Epidural Analgesia following Major Upper Abdominal Surgery Naoji Umemura and Toshiya Koitabashi Department of Anesthesiology, Ichikawa General Hospital, Tokyo Dental College We evaluated the efficacy and safety of 72 hour epidural infusion of 0.2% ropivacaine combined with fentanyl and measured the impact of the difference of the infusion rate on the quality of postoperative pain relief and the incidence of adverse effects following major upper abdominal surgery. Seventy-eight patients who underwent major upper abdominal surgery were enrolled in this study. Anesthesia was maintained with combined general and thoracic epidural anesthesia. At the end of the operation, the patients were randomly allocated into two groups. The patients in Groups F-2 and F-4 received postoperative continuous epidural infusion of 0.2% ropivacaine in combination with fentanyl 6.7microg/kg/day at the rates of 2ml/hr and 4ml/hr for 72 hours following surgery, respectively. Pain on mobilization was significantly lower in Group F-4 than Group F-2 at 24h and 48h following surgery (median VAS at 24 h: Group F-2 = 30mm, Group F-4 = 20mm). The adverse effects such as nausea, vomiting and numbness of the lower extremities were not different between the two groups. We concluded that continuous epidural administration of 0.2% ropivacaine combined with fentanyl at a rate of 4ml/hr was appropriate for better

25 analgesia following major upper abdominal surgery. Key words : Ropivacaine, Infusion rate, Epidural anesthesia

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indd 12 61 1 2011 原著 1)2)5) 1) 1)2) 1)2)5) 1)3)5) 1)2) 1)2)5) 1)2) 1)2) 2) 2) 4) 1) 1) 2) 3) 4) 5) 2010 10 6 2010 12 6 A Comparative Study of the Effect and Discomfort Produced by Pharyngeal Anesthesia with