Abboud T K, Afrasiabi A, Davidson J, Zhu J, Reyes A, Khoo N, Steffens Z
Department of Anesthesiology, Los Angeles County-University of Southern California Medical Center 90033.
Anesthesiology. 1990 Feb;72(2):233-7.
The influence of two different doses of oral naltrexone on the adverse effects and the analgesia of epidural morphine were compared in a double-blind, placebo-controlled study. Forty-five patients undergoing cesarean section were provided postoperative analgesia with 4 mg epidural morphine. Five minutes later they received 6 mg naltrexone, 9 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale (VAS) and by direct questioning of the patients. Requirement for additional analgesics and side effects were noted. Respiratory effects of epidural morphine and naltrexone were assessed using the ventilatory responses to CO2 and by monitoring O2 saturation (Spo2) using pulse oximetry. All patients in the placebo group had adequate analgesia. One of the 15 patients who received naltrexone 6 mg had inadequate analgesia versus five of the 15 patients who received naltrexone 9 mg (P less than 0.05), 9 mg versus placebo. Ten patients (67%) in the placebo group had pruritus while no patient in the 6 mg naltrexone group and one patient in the 9 mg group experienced mild pruritus (P less than 0.05), placebo versus other two groups. The CO2 response slopes were depressed compared to control values from 6-16 h in the placebo group, from 6-12 h in the 6 mg naltrexone group. No significant depression was noted in the 9 mg naltrexone group. The authors conclude that oral naltrexone 6 mg significantly reduces the incidence of pruritus associated with epidural morphine without affecting analgesia and that 9 mg naltrexone is associated with shorter duration of analgesia than 6 mg naltrexone.
在一项双盲、安慰剂对照研究中，比较了两种不同剂量的口服纳曲酮对硬膜外吗啡不良反应和镇痛效果的影响。45例行剖宫产手术的患者术后接受4mg硬膜外吗啡镇痛。5分钟后，他们分别口服6mg纳曲酮、9mg纳曲酮或安慰剂溶液。通过视觉模拟评分法（VAS）和直接询问患者来评估疼痛缓解情况。记录额外镇痛药物的需求和副作用。使用对二氧化碳的通气反应以及通过脉搏血氧饱和度仪监测血氧饱和度（Spo2）来评估硬膜外吗啡和纳曲酮对呼吸的影响。安慰剂组所有患者镇痛效果良好。接受6mg纳曲酮的15名患者中有1名镇痛效果不佳，而接受9mg纳曲酮的15名患者中有5名镇痛效果不佳（P<0.05，9mg纳曲酮组与安慰剂组相比）。安慰剂组10名患者（67%）出现瘙痒，而6mg纳曲酮组无患者出现瘙痒，9mg纳曲酮组有1名患者出现轻度瘙痒（P<0.05，安慰剂组与其他两组相比）。与对照组相比，安慰剂组在6至16小时、6mg纳曲酮组在6至12小时时二氧化碳反应斜率降低。9mg纳曲酮组未观察到明显降低。作者得出结论，口服6mg纳曲酮可显著降低硬膜外吗啡相关瘙痒的发生率，且不影响镇痛效果，9mg纳曲酮与6mg纳曲酮相比，镇痛持续时间更短。
