Kilbride M J, Senagore A J, Mazier W P, Ferguson C, Ufkes T
Department of Surgery, Ferguson Hospital, Grand Rapids, Michigan 49503.
Surg Gynecol Obstet. 1992 Feb;174(2):137-40.
The most frequently used postoperative analgesia techniques are intramuscular injection (IM) and patient controlled analgesia (PCA). Recently, the use of epidural catheter injection (EPI) has been done with success. This study was done to prospectively compare these three techniques for postoperative analgesia after extensive operations upon the colon and rectum. Patients were randomized to one of three analgesia groups--IM, intramuscular morphine sulfate; PCA, patient controlled morphine sulfate, and EPI, epidural morphine sulfate. Data collected included age, time to first bowel movement, amount of narcotic, number achieving 75 per cent of preoperative forced vital capacity, postoperative pruritus, headache, nausea and vomiting, respiratory depression, atelectasis or pneumonitis. A visual analog pain scale was used to evaluate postoperative pain severity (0, no; 1, partial; 2, marked, and 3, total relief). Sixty-eight patients were eligible for study (IM, 19; PCA, 22; EPI, 23, and excluded, four). The EPI group required significantly less daily narcotic compared with either the IM or PCA groups (17.0 +/- 6.12 milligrams; 67.8 +/- 26.8 milligrams; 40.5 +/- 20.6 milligrams, respectively, less than 0.05 ANOVA) and total narcotic (81.3 +/- 31.3 milligrams; 355.4 +/- 147.7 milligrams; 215.3 +/- 105.4 milligrams, respectively, p less than 0.05 ANOVA). EPI achieves excellent pain control in more patients with a significantly lower dose of narcotics and significantly fewer pulmonary complications. Therefore, epidural analgesia is the optimal method of postoperative analgesia after extensive abdominal operations.
最常用的术后镇痛技术是肌肉注射（IM）和患者自控镇痛（PCA）。最近，硬膜外导管注射（EPI）已成功应用。本研究旨在前瞻性地比较这三种技术在结肠和直肠广泛手术后的术后镇痛效果。患者被随机分为三个镇痛组之一——IM组，肌肉注射硫酸吗啡；PCA组，患者自控硫酸吗啡；EPI组，硬膜外注射硫酸吗啡。收集的数据包括年龄、首次排便时间、麻醉药量、达到术前用力肺活量75%的人数、术后瘙痒、头痛、恶心和呕吐、呼吸抑制、肺不张或肺炎。采用视觉模拟疼痛量表评估术后疼痛严重程度（0分，无；1分，部分缓解；2分，明显缓解；3分，完全缓解）。68例患者符合研究条件（IM组19例；PCA组22例；EPI组23例，排除4例）。与IM组或PCA组相比，EPI组每日所需麻醉药量显著更少（分别为17.0±6.12毫克；67.8±26.8毫克；40.5±20.6毫克，方差分析P<0.05），总麻醉药量也显著更少（分别为81.3±31.3毫克；355.4±147.7毫克；215.3±105.4毫克，方差分析P<0.05）。EPI能使更多患者获得良好的疼痛控制，且麻醉药剂量显著更低，肺部并发症显著更少。因此，硬膜外镇痛是腹部广泛手术后术后镇痛的最佳方法。
