Boezaart A P, Eksteen J A, Spuy G V, Rossouw P, Knipe M
Department of Anesthesiology, University of Stellenbosch, Tygerberg, Western Cape, South Africa.
Spine (Phila Pa 1976). 1999 Jun 1;24(11):1131-7. doi: 10.1097/00007632-199906010-00013.
A prospective, randomized, double-blind study.
To evaluate the efficacy and safety of three different dosages of intrathecal morphine sulfate for postoperative analgesia after lumbar spinal fusion.
Analgesia and respiratory depression after intrathecal morphine sulfate injection are dose related. The optimal dose to use for major spinal surgery is not known.
Sixty patients undergoing posterolateral lumbar fusion with or without decompression were divided randomly into 3 groups of 20 patients each. Anesthesia, monitoring, and surgery were similar for all patients. Just before closing of the wound, morphine sulfate was injected into the dural sack under direct visualization. Patients in groups 1-3 received 0.2 mg, 0.3 mg, and 0.4 mg morphine, respectively. Routine analgesia, consisting of diclofenac, was prescribed to use if necessary. Measurements were made and compared between the groups at zero hours (on admission to the Intensive Care Unit), 6 hours, 12 hours, 18 hours, and 24 hours after surgery.
At zero hours and at 12 hours after surgery, pain levels were similar in groups 2 and 3, but were significantly higher in group 1 (P < 0.05). The respiratory rate was significantly lower in group 3 than in the other two groups (P < 0.05), and the arterial CO2 tension (PaCO2) was consistently higher in group 3. PaCO2 decreased in all three groups over the first 24 hours. Pruritus and nausea did not differ among the three groups.
For adult patients undergoing posterolateral lumbar fusion, 0.3 mg (0.004 mg/kg) is probably the optimal dose of intrathecal morphine to manage pain.
一项前瞻性、随机、双盲研究。
评估三种不同剂量的鞘内注射硫酸吗啡用于腰椎融合术后镇痛的有效性和安全性。
鞘内注射硫酸吗啡后的镇痛效果和呼吸抑制与剂量相关。大型脊柱手术的最佳使用剂量尚不清楚。
60例行后外侧腰椎融合术（无论是否行减压术）的患者被随机分为3组，每组20例。所有患者的麻醉、监测和手术方式均相似。在伤口缝合前，在直视下将硫酸吗啡注入硬膜囊。第1 - 3组患者分别接受0.2mg、0.3mg和0.4mg吗啡。必要时可使用由双氯芬酸组成的常规镇痛方法。在术后0小时（进入重症监护病房时）、6小时、12小时、18小时和24小时对各组进行测量并比较。
术后0小时和12小时，第2组和第3组的疼痛水平相似，但第1组明显更高（P < 0.05）。第3组的呼吸频率明显低于其他两组（P < 0.05），且第3组的动脉血二氧化碳分压（PaCO2）一直较高。在最初24小时内，三组的PaCO2均下降。三组的瘙痒和恶心情况无差异。
对于行后外侧腰椎融合术的成年患者，0.3mg（0.004mg/kg）可能是鞘内注射吗啡控制疼痛的最佳剂量。
