Draisci Gaetano, Frassanito Luciano, Pinto Raffaella, Zanfini Bruno, Ferrandina Gabriella, Valente Alessio
Department of Anesthesiology, Catholic University of Sacred Heart, Policlinico A. Gemelli, Rome, Italy.
J Opioid Manag. 2009 Jul-Aug;5(4):197-202. doi: 10.5055/jom.2009.0021.
Subarachnoid block is a widely used technique for cesarean section. Opioids adding to the local anesthetics can improve its quality. In this prospective, randomized, double blind, controlled trial, we compared the effects of coadministration of intrathecal sufentanil and morphine with intrathecal sufentanil and a single administration of subcutaneous morphine. Sixty-four pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned to two groups according to the way of administration of morphine: intrathecal sufentanil (5 microg) plus intrathecal morphine (150 microg) (ITM group), and intrathecal sufentanil (5 microg) plus single administration of 10 mg subcutaneous morphine (SCM group). In both groups, the local anesthetic used was hyperbaric bupivacaine 0.5 percent (10 mg). Both groups received 1 g acetaminophen every 6 hours. In the postoperative period, pain was recorded on a 0-100 visual analog scale (VAS) and intravenous tramadol (100 mg) was administered if VAS score was >40 mm. Collateral effects, such as nausea, itching, respiratory depression, and sedation were assessed. VAS scores at rest and on coughing were significantly higher in the SCM group than in the ITM group between 3 and 24 hours. The mean titrated dose of tramadol consumed was also significantly greater in the SCM group than in the ITM group (p < 0.05). The time to first administration of tramadol was lower in the SCM group versus the ITM group (p < 0.05). The incidence of nausea was significantly lower in the SCM group than in the ITM group (p < 0.05). There was no significant group difference in the incidence of pruritus (p > 0.05). In conclusion, coadministration of sufentanil and morphine into the subarachnoid space was effective and provided longer pain relief than intrathecal sufentanil plus a single injection of subcutaneous morphine, despite a higher incidence of side effects such as nausea and vomiting.
蛛网膜下腔阻滞是剖宫产术中广泛应用的技术。在局部麻醉药中添加阿片类药物可提高其效果。在这项前瞻性、随机、双盲、对照试验中，我们比较了鞘内注射舒芬太尼和吗啡联合应用与鞘内注射舒芬太尼和单次皮下注射吗啡的效果。64例计划在脊髓麻醉下择期行剖宫产的孕妇根据吗啡给药方式分为两组：鞘内注射舒芬太尼（5微克）加鞘内注射吗啡（150微克）（ITM组），以及鞘内注射舒芬太尼（5微克）加单次皮下注射10毫克吗啡（SCM组）。两组均使用0.5%的重比重布比卡因（10毫克）作为局部麻醉药。两组均每6小时给予1克对乙酰氨基酚。术后，采用0至100的视觉模拟评分法（VAS）记录疼痛情况，若VAS评分>40毫米，则给予静脉注射曲马多（100毫克）。评估恶心、瘙痒、呼吸抑制和镇静等副作用。在3至24小时内，SCM组静息和咳嗽时的VAS评分显著高于ITM组。SCM组曲马多的平均滴定剂量也显著高于ITM组（p<0.05）。SCM组首次给予曲马多的时间低于ITM组（p<0.05）。SCM组恶心发生率显著低于ITM组（p<0.05）。瘙痒发生率两组间无显著差异（p>0.05）。总之，尽管恶心和呕吐等副作用发生率较高，但鞘内联合注射舒芬太尼和吗啡有效，且比鞘内注射舒芬太尼加单次皮下注射吗啡提供更长时间的疼痛缓解。
