Abboud T K, Zhu J, Reyes A, Miller H, Steffens Z, Afrasiabi K, Afrasiabi A, Sherman G, Emershad B
Department of Anesthesiology, Los Angeles County-University of Southern California Medical Center 90033.
Reg Anesth. 1992 Jan-Feb;17(1):34-6.
The addition of fentanyl to hyperbaric local anesthetics has been shown to reduce the incidence of post dural puncture headache in the obstetric patient. This study was undertaken to evaluate the effects of subarachnoid morphine on the incidence of headache.
Eighty-two healthy patients undergoing cesarean delivery with spinal anesthesia were studied. All patients were hydrated with 1500 ml lactated Ringer's solution. Patients were randomly assigned to receive, in a double-blind fashion, 0.2 mg of either morphine (Group 1, n = 40) or saline (Group 2, n = 42) in 0.2 ml volume mixed with 0.75% bupivacaine in 8.25% dextrose plus 0.2 ml 1:1000 epinephrine. Spinal anesthesia was induced using a 25-gauge spinal needle at L3-4 interspace with the bevel, in most cases, parallel to the dural fibers. Patients were followed for three days to evaluate the incidence and severity of headache using a four-category rank scale (none, mild, moderate, severe). Data were analyzed for statistical significance using Student's t-test or chi-square test as appropriate. A p value less than 0.05 was considered significant. Results. The incidence of post dural puncture headache did not differ significantly between groups. Eight patients in Group 1 versus nine patients in Group 2 developed headache (p greater than 0.05). Similarly, the use of blood patch or intravenous caffeine sodium benzoate to treat the headache did not differ significantly between groups.
It is concluded from our study that subarachnoid morphine did not decrease the incidence of post dural puncture headache in the obstetric patient.
已证实，在高压局部麻醉剂中添加芬太尼可降低产科患者硬膜穿刺后头痛的发生率。本研究旨在评估蛛网膜下腔注射吗啡对头痛发生率的影响。
对82例行脊髓麻醉剖宫产的健康患者进行研究。所有患者均输注1500ml乳酸林格氏液进行水化。患者被随机分为两组，以双盲方式分别接受0.2ml含0.2mg吗啡（第1组，n = 40）或生理盐水（第2组，n = 42），与0.75%布比卡因混合于8.25%葡萄糖中，并加入0.2ml 1:1000肾上腺素。在L3 - 4间隙使用25G脊髓穿刺针诱导脊髓麻醉，大多数情况下针斜面与硬脊膜纤维平行。对患者进行为期三天的随访，使用四级分级量表（无、轻度、中度、重度）评估头痛的发生率和严重程度。根据情况使用Student's t检验或卡方检验对数据进行统计学显著性分析。p值小于0.05被认为具有显著性。结果。两组之间硬膜穿刺后头痛的发生率无显著差异。第1组8例患者与第2组9例患者出现头痛（p大于0.05）。同样，两组之间使用血补丁或静脉注射苯甲酸钠咖啡因治疗头痛的情况也无显著差异。
我们的研究得出结论，蛛网膜下腔注射吗啡并未降低产科患者硬膜穿刺后头痛的发生率。
