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February 18, 2005

エピ考(3)

アナペインが発売された当初,持続エピのレシピにオピオイドを入れる必要はなくなるのではと期待した。実際,バルーン式持続エピのメニューに塩モヒやフェンタを入れず,0.2%アナペインだけにしたこともあったが,どうしても投与速度を上げないと除痛が得られず,痛みがとれるほど速度を上げる(4ml/hぐらい)と血圧が低下することが多かった。最近ではしかたなく,従来のようにオピオイドを混ぜて使っている。しかし,施設によってバルーン式簡易持続注入ポンプの容量や速度が異なっているため,施設ごとの調整が面倒である。0.8ml/hや1ml/hの固定タイプも結構多い。オピオイドを混ぜたとしても,このような低速で充分な鎮痛が得られるとは思えないのだが。また,アナペインの文献などには0.2%を6ml/hで投与するようなことが書いてあるが,こんなに入れると必ず血圧が下がると思う。

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