Vernassiere C, Cornet C, Trechot P, Alla F, Truchetet F, Cuny J F, Commun N, Granel Brocard F, Barbaud A, Schmutz J L
Department of Anesthesiology, Beauregard Hospital, Thionville, France.
J Wound Care. 2005 Jun;14(6):289-93. doi: 10.12968/jowc.2005.14.6.26793.
To assess the efficacy of the topical application of morphine on painful chronic skin ulcers.
A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a 'rescue' treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily.
Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion.
The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies.
评估局部应用吗啡治疗疼痛性慢性皮肤溃疡的疗效。
进行了一项前瞻性双中心对照双盲随机研究，纳入24例疼痛性慢性皮肤溃疡患者，将局部应用吗啡与安慰剂进行对比。每日应用含10毫克盐酸吗啡的安舒凝胶或含安慰剂的安舒凝胶，持续五天。所有患者均接受二级镇痛治疗。数字疼痛评分低于4/10且无需“解救”治疗（硫酸吗啡）表明治疗成功。每天分析治疗的局部和全身耐受性。
24例患者纳入研究，但仅18例开始方案治疗。吗啡组11例患者中仅2例完全缓解，而安慰剂组7例患者中仅1例完全缓解。吗啡的局部和总体耐受性良好。吗啡的外周疗效有待探讨。
结果表明，在疼痛性慢性皮肤溃疡中，局部应用吗啡不能替代通过其他途径（皮下或口服）给予吗啡。全身应用吗啡对外周吗啡受体的刺激可能解释了这些结果与先前研究结果之间的差异。
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