Flisberg P, Rudin A, Linnér R, Lundberg C J F
Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden.
Acta Anaesthesiol Scand. 2003 Apr;47(4):457-65. doi: 10.1034/j.1399-6576.2003.00104.x.
Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population.
During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0-10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/nightmares/confusion, nausea/vomiting, pruritus, orthostatism/leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest.
Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements.
In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low. Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia.
不良反应可能仍会限制外科病房连续硬膜外镇痛和静脉镇痛的使用。本研究推测，术后硬膜外镇痛比静脉注射吗啡更有效，且副作用更少。目的是在大量患者群体中研究这些治疗方法的疗效、不良反应和安全性。
在五年期间，2696例接受大手术的患者接受了硬膜外或静脉镇痛以缓解术后疼痛。这些患者在外科病房接受前瞻性监测。通过数字评分量表（0 - 10）在静息/活动时评估疼痛。记录治疗持续时间、呼吸抑制、镇静/幻觉/噩梦/意识模糊、恶心/呕吐、瘙痒、体位性低血压/腿部无力以及镇痛效果不佳等情况。所有患者静息时的疼痛评分目标是低于4分。
1670例患者使用了硬膜外镇痛，1026例患者使用了静脉注射吗啡。硬膜外镇痛的患者在静息和活动时疼痛较轻。剂量调整、体位性低血压/腿部无力和瘙痒等治疗效果不佳在硬膜外组更为常见。呼吸抑制和镇静/幻觉/噩梦/意识模糊在静脉组中更常发生。与腰段置管相比，胸段硬膜外导管导致运动阻滞发生率较低。
在大量患者群体中，外科病房使用硬膜外和静脉术后镇痛被认为是安全的，不良反应发生率较低。硬膜外镇痛的患者总体疼痛较轻，而静脉注射吗啡镇痛时与阿片类药物相关的副作用更为常见。
