Seki Hiroyuki, Kashiwagi Masanori, Masuda Junichi, Ohyama Nami, Kamata Michihiro
Department of Anesthesiology, Keio University School of Medicine, Tokyo.
Masui. 2005 Apr;54(4):381-6.
Dexamethasone is known to reduce the incidence of postoperative nausea and vomiting, associated with perioperative intrathecal, epidural, or intravenous morphine. However, the effect of dexamethasone on subcutaneous morphine is unclear. Therefore, we evaluated the antiemetic effect of intravenous dexamethasone during continuous subcutaneous infusion of morphine for postoperative pain relief.
Twenty patients scheduled for spinal surgery under general anesthesia were enrolled in this randomized, double-blind, and placebo-controlled study. The dexamethasone group (n=10) received dexamethasone 8 mg and the saline group (n=10) received the same amount of saline before the induction of anesthesia. Anesthesia was maintained with propofol and fentanyl. Postoperative pain was treated with continuous subcutaneous morphine via a patient-controlled analgesia device. Postoperatively patients were assessed during 48 hours for nausea and vomiting.
Nausea or vomiting ascribable to the subcutaneous morphine developed in 40% of the patients in each group (P:NS).
Our results suggest that the single dose of dexamethasone (8 mg) does not reduce postoperative nausea and vomiting associated with continuous subcutaneous infusion of morphine after spinal surgery.
已知地塞米松可降低与围手术期鞘内、硬膜外或静脉注射吗啡相关的术后恶心和呕吐的发生率。然而，地塞米松对皮下注射吗啡的影响尚不清楚。因此，我们评估了在持续皮下输注吗啡以缓解术后疼痛期间静脉注射地塞米松的止吐效果。
本随机、双盲、安慰剂对照研究纳入了20例计划在全身麻醉下进行脊柱手术的患者。地塞米松组（n = 10）在麻醉诱导前接受8 mg地塞米松，生理盐水组（n = 10）接受等量生理盐水。麻醉维持采用丙泊酚和芬太尼。术后疼痛通过患者自控镇痛装置持续皮下注射吗啡进行治疗。术后对患者进行48小时的恶心和呕吐评估。
每组40%的患者出现了与皮下注射吗啡相关的恶心或呕吐（P：无统计学意义）。
我们的结果表明，单剂量地塞米松（8 mg）并不能降低脊柱手术后持续皮下输注吗啡相关的术后恶心和呕吐。
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