Rathmell James P, Pino Carlos A, Taylor Richard, Patrin Terri, Viani Bruce A
Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont.
Anesth Analg. 2003 Nov;97(5):1452-1457. doi: 10.1213/01.ANE.0000083374.44039.9E.
In this series, we examined analgesia and side effects of intrathecal morphine sulfate (ITMS) after hip and knee arthroplasty over a dose range of 0.0-0.3 mg. Eighty patients undergoing hip (n = 40) or knee (n = 40) arthroplasty were randomized to receive ITMS (0.0, 0.1, 0.2, or 0.3 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. Morphine use, pain relief, and side effects were recorded for 24 h. Data were analyzed with analysis of variance and linear regression. After hip arthroplasty, morphine use was less in patients receiving 0.1, 0.2, or 0.3 mg of ITMS than in control patients (P < 0.05). After knee arthroplasty, ITMS did not reduce postoperative morphine requirements. Nausea and vomiting and the incidence of oxygen saturation <93% were similar in all groups. Pruritus was more common after ITMS. Patients receiving 0.2 or 0.3 mg of ITMS were more satisfied with their pain control than those receiving 0.0 or 0.1 mg after both hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than after hip arthroplasty. We conclude that combining small-dose (0.2 mg) ITMS with PCA morphine provides good to excellent pain control in most patients after total hip or knee arthroplasty. However, PCA morphine use was reduced by the addition of ITMS only after hip arthroplasty.
This series examined the need for supplemental analgesics, the quality of analgesia, and the incidence of side effects with intrathecal morphine sulfate (ITMS) for analgesia after hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than hip arthroplasty. Combining small-dose (0.2 mg) ITMS with standard doses of PCA morphine provided good to excellent pain control in most patients and reduced patient-controlled analgesia morphine use after hip, but not knee, arthroplasty.
在本系列研究中，我们检测了鞘内注射硫酸吗啡（ITMS）在0.0 - 0.3mg剂量范围内用于髋关节和膝关节置换术后的镇痛效果及副作用。80例行髋关节（n = 40）或膝关节（n = 40）置换术的患者被随机分组，接受ITMS（0.0、0.1、0.2或0.3mg）治疗。患者自控镇痛（PCA）装置可让患者自由使用额外的镇痛药。记录24小时内吗啡使用量、疼痛缓解情况及副作用。数据采用方差分析和线性回归进行分析。髋关节置换术后，接受0.1、0.2或0.3mg ITMS的患者吗啡使用量少于对照组患者（P < 0.05）。膝关节置换术后，ITMS未降低术后吗啡需求量。所有组恶心呕吐及血氧饱和度<93%的发生率相似。ITMS后瘙痒更常见。髋关节和膝关节置换术后，接受0.2或0.3mg ITMS的患者对疼痛控制的满意度高于接受0.0或0.1mg的患者。膝关节置换术后的镇痛需求高于髋关节置换术后。我们得出结论，在全髋关节或膝关节置换术后，大多数患者将小剂量（0.2mg）ITMS与PCA吗啡联合使用可提供良好至极优的疼痛控制。然而，仅在髋关节置换术后，添加ITMS可减少PCA吗啡的使用。
本系列研究检测了鞘内注射硫酸吗啡（ITMS）用于髋关节和膝关节置换术后镇痛时补充镇痛药的需求、镇痛质量及副作用发生率。膝关节置换术后的镇痛需求高于髋关节置换术后。小剂量（0.2mg）ITMS与标准剂量的PCA吗啡联合使用，在大多数患者中可提供良好至极优的疼痛控制，并减少髋关节而非膝关节置换术后患者自控镇痛吗啡的使用量。
