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对犬类在使用阿片类镇痛药进行术前用药及骨科手术后,硬膜外注射吗啡或吗啡与布比卡因用于术后镇痛的评估。

Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs.

作者信息

Kona-Boun Jean-Jacques, Cuvelliez Sophie, Troncy Eric

机构信息

Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC J2S 7C6, Canada.

出版信息

J Am Vet Med Assoc. 2006 Oct 1;229(7):1103-12. doi: 10.2460/javma.229.7.1103.

Abstract

OBJECTIVE

To evaluate the analgesic efficacy of epidural administration of morphine or a morphine-bupivacaine combination administered before orthopedic surgery in dogs that received opioid premedication.

DESIGN

Prospective, randomized, blinded, clinical study.

ANIMALS

36 healthy adult dogs that underwent elective orthopedic surgery on a pelvic limb.

PROCEDURES

Each dog received 1 of 3 epidural treatments before surgery. Anesthetic and supportive care protocols were standardized. Dogs under going different surgical procedures were randomly allocated among the 3 treatment groups. Respiratory and cardiovascular variables, end-tidal isoflurane concentration, and requirements for rescue analgesia were monitored. Postsurgical analgesia was evaluated with a multiparametric pain scoring system and by determination of rescue analgesia requirements and cortisolemia.

RESULTS

The morphine-bupivacaine combination was associated with lower values than morphine or a saline solution for intraoperative arterial blood pressure; minimum and maximum isoflurane requirements; and postoperative pain scores, rescue analgesia requirements, and plasma cortisol concentrations. Values obtained after administration of morphine alone were not significantly different from those obtained after administration of saline solution for most variables.

CONCLUSIONS AND CLINICAL RELEVANCE

The preoperative epidurally administered morphine-bupivacaine combination induced better analgesia than morphine alone and should be considered for use in clinical patients. The degree of hemodynamic depression associated with the combination was considered acceptable for healthy patients undergoing elective surgery.

摘要

目的

评估在接受阿片类药物术前用药的犬只中,骨科手术前硬膜外给予吗啡或吗啡-布比卡因联合用药的镇痛效果。

设计

前瞻性、随机、盲法临床研究。

动物

36只接受骨盆四肢择期骨科手术的健康成年犬。

步骤

每只犬在手术前接受3种硬膜外治疗中的1种。麻醉和支持护理方案标准化。接受不同手术程序的犬只随机分配到3个治疗组。监测呼吸和心血管变量、呼气末异氟烷浓度以及急救镇痛需求。采用多参数疼痛评分系统并通过测定急救镇痛需求和皮质醇血症来评估术后镇痛效果。

结果

与吗啡或生理盐水相比,吗啡-布比卡因联合用药在术中动脉血压、最低和最高异氟烷需求、术后疼痛评分、急救镇痛需求和血浆皮质醇浓度方面的值更低。对于大多数变量,单独给予吗啡后获得的值与给予生理盐水后获得的值无显著差异。

结论及临床意义

术前硬膜外给予吗啡-布比卡因联合用药比单独使用吗啡诱导出更好的镇痛效果,应考虑用于临床患者。对于接受择期手术的健康患者,与联合用药相关的血流动力学抑制程度被认为是可接受的。

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