Dualé C, Frey C, Bolandard F, Barrière A, Schoeffler P
Département d'Anesthésie-Réanimation, CHU de Clermont-Ferrand, Rue Montalembert, BP69, F-63003 Clermont-Ferrand 1, France.
Br J Anaesth. 2003 Nov;91(5):690-4. doi: 10.1093/bja/aeg249.
Perispinal anaesthesia for Caesarean section allows injection of epidural (ED) or intrathecal (i.t.) morphine to provide long-lasting postoperative analgesia. To compare these two routes, a prospective, randomized, double-blinded study of 53 patients undergoing elective Caesarean section was performed.
Combined spinal-epidural anaesthesia with 6 mg of i.t. hyperbaric bupivacaine plus sufentanil 5 microg, and additional ED lidocaine was used. Additionally, each patient received either 2 mg (2 ml) of ED morphine plus 1 ml of i.t. normal saline (ED group, n=28), or 0.075 mg (1 ml) of i.t. morphine plus 2 ml of ED normal saline (i.t. group, n=25). Additional postoperative analgesia was given in the form of propacetamol and ketoprofen, plus self-administered i.v. morphine.
No major respiratory depression occurred. Time to first demand of morphine was similar in the ED (307.5 min) and i.t. (310 min) groups, as was the incidence of side-effects such as sedation, pruritus, nausea, and vomiting. During the first 24 postoperative hours, VAS pain scores were greater in the i.t. group (P=0.032), as was additional morphine consumption (4 vs 1.5 mg) (P=0.03).
The ED protocol was more effective than the i.t. protocol, whilst side-effects were similar.
剖宫产术的脊柱旁麻醉允许注射硬膜外（ED）或鞘内（i.t.）吗啡以提供持久的术后镇痛。为比较这两种途径，对53例行择期剖宫产术的患者进行了一项前瞻性、随机、双盲研究。
采用联合腰麻-硬膜外麻醉，鞘内注射6mg重比重布比卡因加5μg舒芬太尼，并追加硬膜外利多卡因。此外，每位患者接受2mg（2ml）硬膜外吗啡加1ml鞘内生理盐水（硬膜外组，n = 28），或0.075mg（1ml）鞘内吗啡加2ml硬膜外生理盐水（鞘内组，n = 25）。术后额外的镇痛采用丙帕他莫和酮洛芬的形式，加患者自控静脉注射吗啡。
未发生严重呼吸抑制。硬膜外组（307.5分钟）和鞘内组（310分钟）首次需要吗啡的时间相似，镇静、瘙痒、恶心和呕吐等副作用的发生率也相似。术后24小时内，鞘内组的视觉模拟评分（VAS）疼痛评分更高（P = 0.032），额外吗啡消耗量也更高（4mg对1.5mg）（P = 0.03）。
硬膜外给药方案比鞘内给药方案更有效，而副作用相似。
