剖宫产术中预防脊髓麻醉追加所需鞘内注射二醋吗啡的最小剂量。

Minimum dose of intrathecal diamorphine required to prevent intraoperative supplementation of spinal anaesthesia for Caesarean section.

作者信息

Saravanan S, Robinson A P C, Qayoum Dar A, Columb M O, Lyons G R

机构信息

Obstetric Anaesthesia, St James's University Hospital, Leeds, UK.

出版信息

Br J Anaesth. 2003 Sep;91(3):368-72. doi: 10.1093/bja/aeg197.

DOI:10.1093/bja/aeg197

PMID:12925476

Abstract

BACKGROUND

Intraoperative discomfort during spinal anaesthesia for Caesarean section is the commonest cited anaesthetic cause of litigation in obstetric practice. Intrathecal opioids are used to improve intraoperative comfort and postoperative analgesia for these operations. The minimum intrathecal diamorphine dose that prevents intraoperative supplementation requires determination.

METHOD

After ethics committee approval, 200 ASA I, II women with > or = 37 weeks gestation and planned for elective Caesarean section under combined spinal-epidural anaesthesia were recruited. They were randomized into four groups to receive hyperbaric bupivacaine 0.5% 12.5 mg with diamorphine 0.2, 0.3, 0.4 or 0.5 mg by intrathecal injection. The need for intraoperative i.v. supplementation with alfentanil, time to first requests for postoperative analgesia, incidence of nausea and vomiting and requirement for antiemetic and antipruritic were noted.

RESULTS

Intraoperative supplementation was inversely proportional to the dose of diamorphine used (P=0.004). The ED(95) value for intrathecal diamorphine to prevent intraoperative supplementation was 0.39 mg. Mean time interval for request for postoperative analgesia was 446 min in the 0.2 mg group, 489 min in the 0.3 mg group, 601 min in the 0.4 mg group and 687 min in the 0.5 mg group (P=0.003 for trend). Incidence of nausea, vomiting and pruritus increased with dose of diamorphine used (P values for trend: nausea, 0.04; vomiting, 0.008; pruritus, 0.004). Requests for antiemetic increased with dose but achieved significance only for requirement for second antiemetic (P=0.03). Request for antipruritic did not achieve significance.

CONCLUSION

The ED(95) for the amount of intrathecal diamorphine required to prevent intraoperative supplementation during spinal anaesthesia for Caesarean section is 0.4 mg in clinical terms. Times to first requests for analgesia, incidence of nausea, vomiting and pruritus increase with dose.

摘要

背景

剖宫产脊髓麻醉期间的术中不适是产科实践中最常被提及的麻醉相关诉讼原因。鞘内注射阿片类药物用于改善这些手术的术中舒适度和术后镇痛效果。需要确定预防术中追加药物所需的最低鞘内吗啡剂量。

方法

经伦理委员会批准，招募了200例妊娠≥37周、计划在腰麻-硬膜外联合麻醉下行择期剖宫产的ASA I、II级女性。她们被随机分为四组，通过鞘内注射分别接受0.5%重比重布比卡因12.5 mg加吗啡0.2、0.3、0.4或0.5 mg。记录术中静脉追加阿芬太尼的需求、首次要求术后镇痛的时间、恶心呕吐的发生率以及使用止吐药和止痒药的需求。

结果

术中追加药物与所用吗啡剂量成反比（P = 0.004）。预防术中追加药物所需的鞘内吗啡ED(95)值为0.39 mg。0.2 mg组首次要求术后镇痛的平均时间间隔为446分钟，0.3 mg组为489分钟，0.4 mg组为601分钟，0.5 mg组为687分钟（趋势P = 0.003）。恶心、呕吐和瘙痒的发生率随所用吗啡剂量增加而升高（趋势P值：恶心，0.04；呕吐，0.008；瘙痒，0.004）。止吐药的需求随剂量增加，但仅在需要第二次使用止吐药时具有统计学意义（P = 0.03）。止痒药的需求无统计学意义。