患者自控镇痛：剖宫产术后硬膜外注射芬太尼与静脉注射吗啡的比较

Patient-controlled analgesia: epidural fentanyl and i.v. morphine compared after caesarean section.

作者信息

Cooper D W, Saleh U, Taylor M, Whyte S, Ryall D, Kokri M S, Desira W R, Day H, McArthur E

机构信息

South Cleveland Hospital, UK.

出版信息

Br J Anaesth. 1999 Mar;82(3):366-70. doi: 10.1093/bja/82.3.366.

DOI:10.1093/bja/82.3.366

PMID:10434817

Abstract

We have compared patient-controlled epidural fentanyl (PCEF) and patient-controlled i.v. morphine (PCIM) after Caesarean section in 84 patients, in a randomized, double-blind study. All patients had an epidural and an i.v. patient-controlled analgesia (PCA) device, one of which delivered normal saline. Group PCEF received epidural fentanyl 20 micrograms with a 10-min lockout. Group PCIM received i.v. morphine 1 mg with a 5-min lockout. PCA use was lower for PCEF patients (P = 0.0007). The highest pain score recorded at rest for PCEF patients was median 20 (interquartile range 10-33) mm compared with 32 (14-52) mm for PCIM patients (P = 0.02). The highest pain score recorded on coughing was 31 (21-41) mm with PCEF compared with 56 (30-71) mm for PCIM (P = 0.001). There was less nausea (P = 0.02) and drowsiness (P = 0.0003) with PCEF. There was no difference in the overall incidence and severity of pruritus (P = 0.77). However, pruritus started earlier with PCEF.

摘要

在一项随机双盲研究中，我们对84例剖宫产术后患者使用自控硬膜外芬太尼（PCEF）和自控静脉注射吗啡（PCIM）进行了比较。所有患者均配备硬膜外和静脉自控镇痛（PCA）装置，其中一个输送生理盐水。PCEF组接受硬膜外注射20微克芬太尼，锁定时间为10分钟。PCIM组接受静脉注射1毫克吗啡，锁定时间为5分钟。PCEF患者的PCA使用量较低（P = 0.0007）。PCEF患者静息时记录的最高疼痛评分为中位数20（四分位间距10 - 33）mm，而PCIM患者为32（14 - 52）mm（P = 0.02）。PCEF组咳嗽时记录的最高疼痛评分为31（21 - 41）mm，PCIM组为56（30 - 71）mm（P = 0.001）。PCEF组的恶心（P = 0.02）和嗜睡（P = 0.0003）较少。瘙痒的总体发生率和严重程度无差异（P = 0.77）。然而，PCEF组瘙痒出现得更早。