Abouleish E, Rawal N, Shaw J, Lorenz T, Rashad M N
Department of Anesthesiology, University of Texas Medical School, Houston.
Anesthesiology. 1991 Apr;74(4):711-6. doi: 10.1097/00000542-199104000-00015.
To compare the efficacy and side effects of 0.2 mg intrathecal (IT) morphine with 0.125% epidural bupivacaine, 62 women in labor were studied. They were randomly divided into three groups: group 1 (n = 20) received IT morphine; group 2 (n = 22) received epidural bupivacaine; and group 3 (n = 20) received a combination of both using a combined spinal-epidural (CSE) technique. According to a visual analogue scale for assessing analgesia, neither IT 0.2 mg morphine nor 10 ml 0.125% epidural bupivacaine was effective in producing adequate pain relief in labor, whereas the combination produced excellent analgesia. The use of IT morphine significantly reduced the dosage requirement of epidural bupivacaine. The incidence of nausea, vomiting, and pruritus was significantly higher when IT morphine had been administered, whereas that of urinary retention did not differ. No serious respiratory depression occurred in any of the patients. When the course of labor was studied, the prior use of IT morphine significantly prolonged the duration of the first stage of labor and the total duration of labor. We conclude that the administration of 0.2 mg IT morphine in combination with epidural administration of 0.125% bupivacaine provides better analgesia than the administration of either drug alone.
为比较鞘内注射（IT）0.2毫克吗啡与0.125%硬膜外布比卡因的疗效和副作用，对62名分娩期女性进行了研究。她们被随机分为三组：第1组（n = 20）接受鞘内注射吗啡；第2组（n = 22）接受硬膜外布比卡因；第3组（n = 20）采用联合腰麻-硬膜外麻醉（CSE）技术接受两者联合使用。根据用于评估镇痛效果的视觉模拟量表，鞘内注射0.2毫克吗啡和10毫升0.125%硬膜外布比卡因均不能有效缓解分娩时的疼痛，而联合用药产生了极佳的镇痛效果。鞘内注射吗啡显著降低了硬膜外布比卡因的用量需求。使用鞘内注射吗啡时，恶心、呕吐和瘙痒的发生率显著更高，而尿潴留的发生率无差异。所有患者均未发生严重的呼吸抑制。研究分娩过程时，预先使用鞘内注射吗啡显著延长了第一产程和总产程。我们得出结论，鞘内注射0.2毫克吗啡联合硬膜外注射0.125%布比卡因比单独使用任何一种药物提供更好的镇痛效果。
