Ben-Abraham R, Beltrutti D, Niv D, Weinbroum A
Department of Anesthesiology, Tel-Aviv Sourasky Medical Center, Israel.
Harefuah. 2001 Aug;140(8):709-12, 806.
Concurrent administration of opioids with different affinity produces synergistic antinociceptive effect in rats. We tested the perioperative antinociceptive effects of the simultaneous double blind administration of morphine, a pure agonist and buprenorphine, a partial agonist, in 30 patients undergoing hysterectomy under general anesthesia. Pre- and post-operatively regimens consisted of random patient assignment to intrathecal 0.3 mg morphine plus intravenous saline (group 1), intravenous 0.09 mg buprenorphine plus intrathecal saline (group 2) or intrathecal morphine 0.3 mg plus intravenous buprenorphine 0.09 mg (group 3). Postoperative pain relief for group 3 consisted of supplementation of intravenous buprenorphine plus intrathecal saline. The immediate postoperative pain, sedation and anxiety levels (by numerical or categorical scores) were similar among all groups. The 12-hour pain and sedation scores were significantly (P < 0.05) lower in group 3 than in the other two groups. Buprenorphine-induced analgesia in group 3 lasted significantly (P < 0.05) longer than in group 2. Side effects in groups 2 and 3 were by 44% and 42% fewer than in group 1, respectively, with no withdrawal symptoms. Thus, concomitant administration of intrathecal morphine and low dose intravenous buprenorphine produces better and longer pain relief than intravenous buprenorphine alone in women after hysterectomy.
同时给予具有不同亲和力的阿片类药物会在大鼠中产生协同的镇痛作用。我们对30例接受全身麻醉下子宫切除术的患者进行了吗啡（一种纯激动剂）和丁丙诺啡（一种部分激动剂）同时双盲给药的围手术期镇痛效果测试。术前和术后方案包括将患者随机分配至鞘内注射0.3mg吗啡加静脉注射生理盐水（第1组）、静脉注射0.09mg丁丙诺啡加鞘内注射生理盐水（第2组）或鞘内注射0.3mg吗啡加静脉注射0.09mg丁丙诺啡（第3组）。第3组术后疼痛缓解包括补充静脉注射丁丙诺啡加鞘内注射生理盐水。所有组之间术后即刻的疼痛、镇静和焦虑水平（通过数字或分类评分）相似。第3组的12小时疼痛和镇静评分显著低于其他两组（P<0.05）。第3组中丁丙诺啡诱导的镇痛持续时间显著长于第2组（P<0.05）。第2组和第3组的副作用分别比第1组少44%和42%，且无戒断症状。因此，对于子宫切除术后的女性，鞘内注射吗啡和低剂量静脉注射丁丙诺啡联合给药比单独静脉注射丁丙诺啡能产生更好、更持久的疼痛缓解效果。
