Beaussier Marc, Weickmans Henri, Parc Yann, Delpierre Eric, Camus Yvon, Funck-Brentano Christian, Schiffer Eduardo, Delva Eric, Lienhart André
Department of Anesthesiology and Intensive Care, Hospital St-Antoine, APHP, Université Pierre et Marie Curie Paris VI, Paris, France.
Reg Anesth Pain Med. 2006 Nov-Dec;31(6):531-8. doi: 10.1016/j.rapm.2006.06.250.
Intrathecal morphine is a widely used method for postoperative pain relief after major abdominal surgery. The aim of this randomized, double-blinded study was to compare intrathecal morphine and intravenous PCA morphine for postoperative analgesia and recovery course after major colorectal surgery in elderly patients.
After written informed consent, patients >70 years of age were prospectively and randomly assigned to receive either preoperative intrathecal morphine (0.3 mg) and postoperative patient-controlled (PCA) intravenous morphine (IT morphine) or PCA alone (group control). Results are presented as mean +/- SD (95% confidence interval).
Twenty-six patients successfully completed the study in each group. In the IT morphine group, rate of awakening was delayed. Pain intensity and daily intravenous morphine consumption were significantly reduced 1 and 2 days after surgery in the IT morphine group (P < .01). Mental function (assessed by Mini Mental State and Digit Symbol Substitution Test) was similar in both groups. Episodes of postoperative delirium/confusion occurred similarly in both groups. Time to ileus resolution and time to ambulation without assistance did not differ between the 2 groups. The duration of hospitalization was 8.4 +/- 1.7 (7-11) days and 7.9 +/- 2.0 (6-9.9) days for control and IT morphine, respectively (nonstatistical difference). Patients in the IT morphine group had longer time to awakening from anesthesia and experienced more sedation.
Intrathecal morphine, as compared with intravenous PCA morphine alone, improves immediate postoperative pain and reduces parenteral morphine consumption but does not improve postoperative recovery in elderly patients after major colorectal surgery.
鞘内注射吗啡是腹部大手术后广泛应用的术后镇痛方法。本随机双盲研究旨在比较鞘内注射吗啡与静脉自控镇痛吗啡用于老年患者大肠大手术后的术后镇痛及恢复过程。
在获得书面知情同意后，对年龄大于70岁的患者进行前瞻性随机分组，分别接受术前鞘内注射吗啡（0.3mg）及术后静脉自控（PCA）吗啡（鞘内吗啡组）或单纯PCA（对照组）。结果以均值±标准差（95%置信区间）表示。
每组均有26例患者成功完成研究。鞘内吗啡组患者苏醒延迟。鞘内吗啡组术后第1天和第2天的疼痛强度及每日静脉吗啡用量显著降低（P < 0.01）。两组的精神功能（通过简易精神状态检查表和数字符号替换测验评估）相似。两组术后谵妄/意识模糊的发生率相似。两组在肠梗阻缓解时间及无需协助即可行走的时间方面无差异。对照组和鞘内吗啡组的住院时间分别为8.4±1.7（7 - 11）天和7.9±2.0（6 - 9.9）天（无统计学差异）。鞘内吗啡组患者麻醉苏醒时间更长，且镇静程度更高。
与单纯静脉PCA吗啡相比，鞘内注射吗啡可改善术后即刻疼痛并减少胃肠外吗啡用量，但在老年患者大肠大手术后并不能改善术后恢复情况。
