Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College, Asahikawa, 078-8510, Japan.
J Clin Anesth. 2010 Jun;22(4):268-73. doi: 10.1016/j.jclinane.2009.09.003.
To evaluate the analgesia following cesarean delivery and the frequency of side effects of intrathecal morphine when combined with a continuous epidural infusion.
Randomized, double-blinded study.
University hospital.
76 ASA physical status I and II term parturients undergoing cesarean delivery with combined spinal-epidural anesthesia.
Patients were randomized to one of three groups to receive 0, 50, or 100 microg (Group 0, Group 50, and Group 100, respectively) intrathecal morphine in addition to 8 mg of hyperbaric bupivacaine. Each patient received a continuous epidural infusion of 0.2% ropivacaine at the rate of 6 mL/hr.
24-hour visual analog pain scores (VAPS), number of patients who requested rescue analgesics, frequency of requests for rescue analgesics per patient, and time interval before the first request for rescue analgesics were recorded. Frequency of pruritus and postoperative nausea and vomiting (PONV) were also recorded.
Group 50 and Group 100 patients exhibited lower VAPS and longer time intervals before the first request for rescue analgesics, and they requested rescue analgesics less frequently than Group 0 patients. The frequency of pruritus was significantly higher in Group 100 than Group 0. The groups did not differ with regard to PONV.
50 microg and 100 microg of intrathecal morphine improve analgesia when combined with a continuous epidural infusion of 0.2% ropivacaine (6 mL/hr) after cesarean delivery. 50 microg of intrathecal morphine is associated with a low frequency of side effects such as pruritus and PONV.
评估剖宫产术后镇痛效果和鞘内注射吗啡联合连续硬膜外输注时的副作用发生率。
随机、双盲研究。
大学医院。
76 例 ASA 身体状况 I 和 II 级足月产妇，行脊髓-硬膜外联合麻醉剖宫产术。
患者随机分为三组，分别鞘内注射 0、50 或 100μg 吗啡（分别为组 0、组 50 和组 100），同时给予 8mg 重比重布比卡因。每位患者均接受 0.2%罗哌卡因持续硬膜外输注，速度为 6mL/h。
记录 24 小时视觉模拟疼痛评分（VAPS）、需要补救镇痛的患者人数、每位患者要求补救镇痛的频率以及首次要求补救镇痛的时间间隔。记录瘙痒和术后恶心呕吐（PONV）的发生频率。
组 50 和组 100 患者的 VAPS 评分较低，首次要求补救镇痛的时间间隔较长，要求补救镇痛的频率也低于组 0 患者。组 100 的瘙痒发生率明显高于组 0。三组在 PONV 发生率方面无差异。
鞘内注射 50μg 和 100μg 吗啡联合 0.2%罗哌卡因（6mL/h）持续硬膜外输注可改善剖宫产术后镇痛效果。鞘内注射 50μg 吗啡与瘙痒和 PONV 等副作用的低发生率相关。
