Prasartritha Thavat, Kunakornsawat Sombat, Tungsiripat Rachata, Jampa Jaruat, Throngnumchai Roongnapa
Center of Excellence in Orthopedics, Lerdsin General Hospital, Bangkok, Thailand.
J Spinal Disord Tech. 2010 Dec;23(8):e43-6. doi: 10.1097/BSD.0b013e3181cd3048.
A randomized, controlled trial.
To compare the efficacy of pain control and complications between patients utilizing continuous infusion epidural morphine versus intravenous morphine in posterior spinal surgery.
Recently, there has been increased interest in the use of epidural infusion analgesia for spinal surgery. By simply placing the tip of catheter at the level of operation before the wound closure, a continuous infusion of local anesthetics is directly delivered into the epidural space. Techniques used in the literature vary as per analgesic agents, number of catheters, and the infusion method. Few are the randomized control studies.
A total of 120 patients, who had posterior spinal operations, were randomly assigned to receive either continuous epidural infusion morphine, continuous epidural infusion morphine with Bupivacaine, or intravenous morphine as a postoperative analgesia. Visual analogue Pain scale (Pain VAS) was evaluated every 4 hours the first day, and at 36 and 48 hours postoperatively. Additional doses of intravenous Nalbuphine hydrochloride, complications, and the satisfaction score were recorded.
Baseline characteristics of the 3 groups were similar. The mean Pain VAS in the epidural morphine group (groups 1 and 2) were less than that of group 3 at all times up to 48 hours postoperatively (P<0.05). Pain VAS for group 1 was more than that of group 2 at the 16- and 24-hour marks (P<0.05). Pruritus was a common complication in the epidural morphine group. There was no respiratory depression in this study. Patients in groups 1 and 2 had a high proportion of excellent and very good satisfaction (70% to 80%).
Epidural infusion analgesia is safe and effective for posterior spinal surgery.
一项随机对照试验。
比较后路脊柱手术中使用持续输注硬膜外吗啡与静脉注射吗啡的患者在疼痛控制效果及并发症方面的差异。
最近，硬膜外输注镇痛在脊柱手术中的应用受到越来越多的关注。通过在伤口缝合前将导管尖端置于手术平面，可将局部麻醉药持续输注直接送达硬膜外间隙。文献中使用的技术因镇痛药物、导管数量和输注方法而异。随机对照研究较少。
总共120例行后路脊柱手术的患者被随机分配接受持续硬膜外输注吗啡、持续硬膜外输注吗啡联合布比卡因或静脉注射吗啡作为术后镇痛。术后第一天每4小时评估一次视觉模拟疼痛量表（疼痛视觉模拟评分，Pain VAS），并在术后36小时和48小时进行评估。记录静脉注射盐酸纳布啡的额外剂量、并发症及满意度评分。
3组的基线特征相似。硬膜外吗啡组（第1组和第2组）术后48小时内各时间点的平均疼痛视觉模拟评分均低于第3组（P<0.05）。第1组在16小时和24小时时的疼痛视觉模拟评分高于第2组（P<0.05）。瘙痒是硬膜外吗啡组的常见并发症。本研究中未出现呼吸抑制。第1组和第2组患者的满意度为优秀和非常好的比例较高（70%至80%）。
硬膜外输注镇痛用于后路脊柱手术安全有效。
