Objective To evaluate the analgesic effect of low-dose lidocaine in remifentanil-based anesthesia. Methods Forty patients undergoing thoracic surgery were randomly assigned to low-dose lidocaine 33 μg. Kg-1 .min-1 and saline supplementation control groups in remifentanil-based anesthesia 0. 2 μg · kg-1· min 1· The setting of plasma concentration (Cp) of target-controlled infusion (TCI) propofol was adjusted according to bispectral index of electroencephalogram (BIS) and blood pressure. Pain score including verbal rating scale (VRS-4), sedation-agitation scale (SAS) and visual analog scale (VAS), and morphine requirement in postanesthesia care unit (PACU) and morphine consumption via patient-controlled analgesia (PCA) device in ward were recorded during the postoperative period. Results Morphine requirement within 30、60、120 min in PACU of group L decreased significantly than(P<0. 05). In addition, the scales of VAS 6 h on coughing and PCA morphine consumption during 2-6 h postoperative time were significantly (P<0. 05) improved in group L. The analgesic effect of lidocaine could be observed when the serum concentration is higher than(0. 34± 0.18)μg/ml. Conclusion It could reduce remifentanil-induced postoperative pain when lidocaine serum concentration is higher than (0. 34 + 0. 18)μg/ml.%目的 观察小剂量利多卡因静脉输注能否减轻瑞芬太尼停药后疼痛.方法 选择40例择期行剖胸手术的患者,随机均分为两组:利多卡因组(L组)及对照组(C组).两组术中均输注瑞芬太尼0.2μg?kg-1?min-.L组同时输注利多卡因33μg?kg-1?min-1,C组输注等容积生理盐水.根据脑电双频指数(BIS)和MAP调整靶控输注(TCI)丙泊酚血浆浓度.记录麻醉后恢复室(PACU)内疼痛评分-4 (VRS-4),Ricker's镇静躁动(SAS)评分及吗啡用量；拔管后48 h疼痛VAS评分和患者自控镇痛(PCA)的吗啡用量.L组患者测定利多卡因血药浓度.结果 拔管后30、60、120 min吗啡用量L组明显低于C组(P＜0.05).拔管后6 hPCA吗啡用量L组明显低于C组(P＜0.05).拔 管后6hL组咳嗽时VAS评分低于C组(P＜0.05).拔管后6h内利多卡因血药浓度＞(0.34±0.18)μg/ml,L组PCA吗啡用量低于C组(P＜0.05).结论 利多卡因血药浓度＞(0.34土0.18)μg/ml时,能起到减轻瑞芬太尼停药后疼痛的作用.
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