Wolf A R, Hughes D, Hobbs A J, Prys-Roberts C
Sir Humphry Davy Department of Anaesthesia, University of Bristol, Bristol Royal Hospital for Sick Children, England.
Anaesth Intensive Care. 1991 Feb;19(1):17-21. doi: 10.1177/0310057X9101900103.
We wished to determine if the addition of a small dose of morphine (0.05 mg.kg-1) to a caudal solution of 0.25% bupivacaine could extend the duration of analgesia after major reconstructive penile surgery and also to measure the systemic absorption of morphine after caudal injection. Thirty children undergoing reconstructive penile surgery received a caudal injection of 0.25% bupivacaine 0.75 ml.kg-1 with or without morphine 0.05 mg.kg-1. All patients awoke pain-free, but eight of the fifteen patients receiving bupivacaine alone required supplementary injections of opioid postoperatively, whereas none of the patients receiving the bupivacaine-morphine mixture required additional opioids. The incidence of side-effects was similar for the two groups. Morphine was absorbed rapidly after caudal injection to reach a peak plasma level of 21.2 (+/- 4.8) ng.ml-1 at ten minutes and then fell to 10.1 (+/- 3.8) ng.ml-1 at one hour and 4.1 (+/- 2.6) ng.ml-1 at three hours. These levels are low compared with plasma levels associated with systemic analgesia. We conclude that the extended duration of analgesia from morphine 0.05 mg/kg given caudally is due at least in part to specific spinal analgesia.
我们希望确定在0.25%布比卡因的骶管溶液中添加小剂量吗啡（0.05 mg·kg-1）是否能延长阴茎重建大手术后的镇痛时间，并测量骶管注射后吗啡的全身吸收情况。30名接受阴茎重建手术的儿童接受了0.75 ml·kg-1的0.25%布比卡因骶管注射，其中部分儿童还添加了0.05 mg·kg-1的吗啡。所有患者苏醒时均无疼痛，但15名单独接受布比卡因的患者中有8名术后需要补充注射阿片类药物，而接受布比卡因-吗啡混合液的患者中无一例需要额外的阿片类药物。两组的副作用发生率相似。骶管注射后吗啡迅速吸收，10分钟时血浆峰值水平达到21.2（±4.8）ng·ml-1，1小时时降至10.1（±3.8）ng·ml-1，3小时时降至4.1（±2.6）ng·ml-1。与全身镇痛相关的血浆水平相比，这些水平较低。我们得出结论，骶管给予0.05 mg/kg吗啡后镇痛时间延长至少部分归因于特定的脊髓镇痛作用。
