Vercauteren M, Vereecken K, La Malfa M, Coppejans H, Adriaensen H
Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium.
Acta Anaesthesiol Scand. 2002 Jan;46(1):85-9. doi: 10.1034/j.1399-6576.2002.460115.x.
Patient-controlled analgesia (PCA) techniques and intrathecal morphine are the most widely used treatments for post-Caesarean section pain. However these methods have not been compared with respect to analgesic quality and cost differences.
Fifty-three patients scheduled for elective or semi-urgent Caesarean section were randomized to receive for postoperative analgesia either epidural PCA with a mixture containing bupivacaine 0.06% and sufentanil 1 microg x ml(-1) or intrathecal morphine 0.15 mg together with the spinal anaesthetic and to be supplemented with paracetamol and tramadol. Analgesic efficacy, side-effects and costs were calculated during 48 h.
VAS pain scores both at rest and during mobilization were lower in the PCA group, more particularly during the second postoperative day. Nausea and vomiting were more frequently registered in the morphine treated patients. PCA treated patients stayed longer in the recovery room but required fewer nurse interventions on the surgical ward. Manpower and drug costs were equal in both groups. The differences in total costs (Euro) amounted to euros 33 and were mainly caused by the more expensive equipment required for epidural PCA. Satisfaction and hospital discharge were similar for both treatments.
It was concluded that epidural PCA induced better pain relief, caused less nausea/vomiting but was more expensive than intrathecal morphine.
患者自控镇痛（PCA）技术和鞘内注射吗啡是剖宫产术后疼痛最常用的治疗方法。然而，这些方法在镇痛质量和成本差异方面尚未进行比较。
53例计划行择期或半急诊剖宫产的患者被随机分为两组，一组接受术后镇痛采用含0.06%布比卡因和1μg/ml舒芬太尼的混合液进行硬膜外PCA，另一组在脊髓麻醉时鞘内注射0.15mg吗啡，并辅以对乙酰氨基酚和曲马多。计算48小时内的镇痛效果、副作用和成本。
PCA组静息和活动时的视觉模拟评分（VAS）疼痛评分较低，尤其是在术后第二天。吗啡治疗组患者恶心和呕吐的发生率更高。PCA治疗组患者在恢复室停留时间更长，但在外科病房所需的护士干预较少。两组的人力和药物成本相当。总成本差异（欧元）为33欧元，主要是由于硬膜外PCA所需设备更昂贵。两种治疗方法的满意度和出院情况相似。
得出的结论是，硬膜外PCA镇痛效果更好，恶心/呕吐发生率更低，但比鞘内注射吗啡更昂贵。
