纳布啡与芬太尼作为布比卡因鞘内辅助剂在骨科手术中的比较：一项随机对照双盲试验

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纳布啡与芬太尼作为布比卡因鞘内辅助剂在骨科手术中的比较：一项随机对照双盲试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：邓举   编辑：马艳燕  审校：曹莹

1   背景和目的  

鞘内佐剂与局麻药一起使用，可以延长麻醉持续时间，缓解术后疼痛，同时尽量减少局麻药的剂量。纳布啡是一种阿片受体激动-拮抗剂，可延长镇痛时间，具有较少的芬太尼的副作用，如瘙痒、恶心和呕吐。本研究的目的是评估和比较在骨科下肢手术中，纳布芬和芬太尼联合0.5%重比重布比卡因鞘内给药后感觉和运动阻滞的发生和持续时间、血流动力学效应、术后镇痛持续时间以及不良反应。

2   材料和方法  

纳入了66例ASA分级I级和II级择期行下肢骨科手术的患者。患者被随机分配到鞘内注射15mg重比重比卡因和1mg纳布啡(N组)、25µg芬太尼(F组)或0.9%生理盐水(C组)。

3   结果  

与接受芬太尼治疗的患者(F组)相比，接受鞘内纳布啡治疗的患者(N组)的感觉和运动阻滞起效明显延迟。与N组（114.55±10.90分钟）相比，F组（122.05±10.65分钟）的两节段回归时间显著延长[P<0.05] 。与N组（180.68±15.68分钟）相比，F组（197.73±15.09分钟）的平均运动阻滞持续时间显著延长[P<0.05] 。N组（323.18±57.39分钟）和F组（287.05±78.87分钟）的脊髓镇痛持续时间具有可比性，均显著高于C组（224.32±42.54分钟）。N组和F组的血流动力学效应、24小时抢救镇痛需求和副作用发生率具有可比性。

  4   结论

当作为布比卡因在下肢骨科手术时的鞘内辅助剂，1mg纳布啡可替代25µg芬太尼产生相同作用。镇痛持续时间延长，且无不良反应，使其成为下肢骨科手术的良好选择。

原始文献来源：

Sharma A, Chaudhary S, Kumar M, et al.Comparison of nalbuphine versus fentanyl as intrathecal adjuvant to bupivacaine for orthopedic surgeries: A randomized controlled double-blind trial. [J]Anesthesiol Clin Pharmacol 2021;37:529-36.

英文原文：

Comparison of nalbuphine versus fentanyl as intrathecal adjuvant to bupivacaine for orthopedic surgeries: A randomized controlled double‑blind trial

Background and Aims: Intrathecal adjuvants are used with local anesthetics to prolong the duration and provide postoperative pain relief while minimizing the dose of local anesthetic. Nalbuphine is an agonist-antagonist opioid and provides prolonged duration of analgesia with fewer side effects of fentanyl such as pruritus, nausea, and vomiting. The aim of this study was to evaluate and compare the onset and duration of sensory and motor blockade, hemodynamic effects, duration of postoperative analgesia, and adverse effects of nalbuphine and fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in orthopedic lower limb surgeries.

Material and Method:Sixty six patients classified in American Society of Anesthesiology (ASA) classes I and II scheduled for orthopedic lower limb surgeries were enrolled. Patients were randomly allocated to receive 15 mg of hyperbaric bupivacaine with either 1 mg nalbuphine (group N), 25 µg fentanyl (group F) or 0.9% normal saline (group C) intrathecally.

Results:: Patients who received intrathecal nalbuphine (group N) had a significantly delayed onset of sensory and motor block as compared to patients who received fentanyl (group F). The time to two segment regression was significantly prolonged in group F (122.05 ± 10.65 minutes) as compared to group N (114.55 ± 10.90 minutes) [P < 0.05]. The mean duration of motor blockade was significantly prolonged in group F (197.73 ± 15.09 minutes) as compared to group N (180.68 ± 15.68 minutes) [P < 0.05]. Duration of spinal analgesia was comparable in group N (323.18 ± 57.39 minutes) and group F (287.05 ± 78.87 minutes), both significantly more than group C (224.32 ± 42.54 minutes). Hemodynamic effects, 24-h rescue analgesic requirements,and incidence of side effects were comparable among group N and F.

Conclusion:Intrathecal nalbuphine in a dose of 1 mg is an equally useful alternative to fentanyl in a dose 25 µg when used as an intrathecal adjuvant to bupivacaine for lower limb surgeries. The prolonged duration of analgesia and no adverse effects makes it a good choice for the orthopedic procedures of lower limb.

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