Gall O, Aubineau J V, Bernière J, Desjeux L, Murat I
Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Armand Trousseau, Paris, France.
Anesthesiology. 2001 Mar;94(3):447-52. doi: 10.1097/00000542-200103000-00014.
This study was designed to assess the postoperative analgesic effect of low-dose intrathecal morphine after scoliosis surgery in children.
Thirty children, 9-19 yr of age, scheduled for spinal fusion, were randomly allocated into three groups to receive a single dose of 0 (saline injection), 2, or 5 microg/kg intrathecal morphine. After surgery, a patient-controlled analgesia device (PCA) provided free access to additional intravenous morphine. Children were monitored for 24 h in the postanesthesia care unit.
The three groups were similar for age, weight, duration of surgery, and time to extubation. The time to first PCA demand was dose-dependently delayed by intrathecal morphine. The first 24 h of PCA morphine consumption was 49 +/- 17, 19 +/- 10, and 12 +/- 12 mg (mean +/- SD) in the saline, 2 microg/kg morphine, and 5 microg/kg morphine groups, respectively. Pain scores at rest were significantly lower over the whole study period after 2 and 5 microg/kg intrathecal morphine than after saline, but there was no difference between intrathecal doses. Pain scores while coughing and the incidence of side effects were similar in the three groups.
These data demonstrate that low-dose intrathecal morphine supplemented by PCA morphine provides better analgesia than PCA morphine alone after spinal fusion in children. The doses of 2 and 5 microg/kg seem to have similar effectiveness and side-effect profiles, whereas a reduction of intraoperative bleeding was observed in patients who received 5 microg/kg but not 2 microg/kg intrathecal morphine.
本研究旨在评估小儿脊柱侧弯手术后低剂量鞘内注射吗啡的术后镇痛效果。
30名年龄在9至19岁、计划进行脊柱融合术的儿童被随机分为三组，分别接受单次剂量为0（注射生理盐水）、2或5微克/千克的鞘内吗啡注射。术后，患者自控镇痛装置（PCA）可提供额外静脉注射吗啡。在麻醉后护理单元对儿童进行24小时监测。
三组在年龄、体重、手术持续时间和拔管时间方面相似。鞘内吗啡使首次PCA需求时间呈剂量依赖性延迟。生理盐水组、2微克/千克吗啡组和5微克/千克吗啡组PCA吗啡的前24小时消耗量分别为49±17、19±10和12±12毫克（平均值±标准差）。在整个研究期间，2和5微克/千克鞘内吗啡注射后静息时的疼痛评分显著低于注射生理盐水后，但鞘内注射剂量之间无差异。三组咳嗽时的疼痛评分和副作用发生率相似。
这些数据表明，小儿脊柱融合术后，鞘内注射低剂量吗啡辅以PCA吗啡比单独使用PCA吗啡提供更好的镇痛效果。2和5微克/千克的剂量似乎具有相似的有效性和副作用特征，而接受5微克/千克而非2微克/千克鞘内吗啡注射的患者术中出血量减少。
