Postoperative pain facilitates nonthermoregulatory tremor

被引:59
作者
Horn, EP
Schroeder, F
Wilhelm, S
Sessler, DI
Standl, T
von dem Busche, K
Esch, JSA
机构
[1] Univ Hosp Eppendorf, Dept Anesthesiol, Outcomes ResTM Grp, D-20246 Hamburg, Germany
[2] Univ Calif San Francisco, Dept Anesthesia, San Francisco, CA 94143 USA
[3] Ludwig Boltzmann Inst Clin Anesthesia & Intens Ca, Vienna, Austria
[4] Univ Vienna, Dept Anesthesia & Gen Intens Care, Vienna, Austria
关键词
clonus; isoflurane; shivering; temperature; thermoregulation; volatile anesthetics;
D O I
10.1097/00000542-199910000-00017
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Spontaneous tremor is relatively common in normothermic patients after operation and has been attributed to many causes. The hypothesis that nonthermoregulatory shivering-like tremor is facilitated by postoperative pain was tested. In addition, the effects of intravenous lidocaine on nonthermoregulatory tremor were evaluated. Methods: Patients undergoing knee surgery were anesthetized with 2 mu g/kg intravenous fentanyl and 0.2 mg/kg etomidate. Anesthesia was maintained with 1.7 +/- 0.8% (mean +/- SD) isoflurane, Intraoperative forced-air heating maintained normothermia. The initial 44 patients were randomly allocated to receive an intra-articular injection of 20 ml saline (n = 23) of lidocaine, 1.5% (n = 21). The subsequent 30 patients were randomly allocated to receive an intravenous bolus of 250 mu g/kg lidocalne followed by an infusion of 13 mu g.kg(-1).h(-1) lidocaine or an equivalent volume of saline when shivering was observed. Patient-controlled analgesia was provided for ail patients: 3.5 mg piritramide, with a lockout interval of 5 min, for an unlimited total dose. Shivering was graded by a blinded investigator using a four-point scale. Pain was assessed by a 100-mm visual analog scale (0 = no pain and 100 = worst pain). The arteriovenous shunt status was evaluated with forearm-minus-fingertip skin-temperature gradients. Results: Morphometric characteristics and hemodynamic responses were similar in the four groups. Core and mean skin temperature remained constant or increased slightly compared with preoperative values, and postoperative skin-temperature gradients were negative (indicating vasodilation) in nearly all patients. After intra-articular injection of saline, pain scores for the first postoperative hour averaged 46 +/- 32 mm (mean +/- SD), and 10 of the 23 (43%) patients shivered. In contrast, the pain scores of patients who received intra-articular lidocaine were significantly reduced to 5 +/- 9 nun and shivering was absent in this group (P < 0.05), In the second portion of the study, neither intravenous lidocaine nor saline reduced the magnitude or duration of nonthermoregulatory tremor or the patients' pain scores. Conclusions: Intra-articular, but not intravenous, lidocaine reduced surgical pain and prevented nonthermoregulatory shivering. Therefore, these data indicate that postoperative pain facilitates nonthermoregulatory shivering.
引用
收藏
页码:979 / 984
页数:6
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