Baftiu Nehat, Hadri Burhan, Mustafa Aziz
University Clinical Center of Kosova, Prishtina, Kosova.
Med Arh. 2010;64(4):231-4.
To compare effects and side effects or complications of epidural versus intramuscularly administered morphine for relieve of postoperative pain.
In the first group (epidural) analgesia is achieved by application of morphine through epidural catheter. To the amount of morphine is added physiological solution until 10 ml of total volume of the mixture is achieved. This mixture is given to 150 patients, by epidural route before the exit from the operation room. Epidural catheter is removed after 48 hours. Second group (intramuscular) analgesia is realized by application of 10 mg of morphine by intramuscular route. Morphine is injected at the end of surgery. Pain is assessed with combination of verbal categorical scale and visual analog scale. Verbal categorical scale used is 8 points scale and contains words of Tursky: 0 no pain, 1 very low pain, 2 week pain, 3 mild pain, 4 moderate pain, 5 strong pain, 6 severe pain, 7 untolerated pain. Awareness is assed during first 24 hours. For this Reynolds 4 points scale is used: awaked 1, somnolent 2, sleepy 3, deep sleep 4.
Pain assessed by visual analog scale (VAS) is 15.17-29.62 in the epidural group patients versus 26.39-70.83 in intramuscular group. Variation of respiration rate in both groups is not significant 22.21 +/- 4.23 and 23.98 +/- 2.72 in minute, in epidural and intramuscular morphine groups, respectively. PaCO2 and PaO2 values are similar without significant variation 35.34 +/- 4.72 mmHg in the epidural morphine group and 31.3 +/- 3.21 mmHg in intramuscular morphine group.
Epidural administration of morphine provides better analgesia in quality, since it is deeper, longer in duration and with less inhibitory supra-spinal actions when compared to intramuscular administered morphine.
比较硬膜外注射与肌肉注射吗啡缓解术后疼痛的效果、副作用及并发症。
第一组（硬膜外组）通过硬膜外导管注入吗啡实现镇痛。向吗啡中加入生理盐水直至混合液总体积达到10毫升。将此混合液在患者离开手术室前经硬膜外途径给予150例患者。48小时后拔除硬膜外导管。第二组（肌肉注射组）通过肌肉注射10毫克吗啡实现镇痛。吗啡在手术结束时注射。采用语言分类量表和视觉模拟量表相结合的方式评估疼痛。所用的语言分类量表为8分量表，包含Tursky的词汇：0级无痛，1级极低度疼痛，2级轻度疼痛，3级轻度疼痛，4级中度疼痛，5级重度疼痛，6级极重度疼痛，7级无法耐受的疼痛。在最初24小时内评估意识状态。为此采用Reynolds 4分量表：清醒1级，嗜睡2级，困倦3级，深睡4级。
硬膜外组患者通过视觉模拟量表（VAS）评估的疼痛为15.17 - 29.62，而肌肉注射组为26.39 - 70.83。两组呼吸频率的变化无显著差异，硬膜外吗啡组和肌肉注射吗啡组分别为每分钟22.21±4.23和23.98±2.72。硬膜外吗啡组的PaCO2和PaO2值相似，无显著变化，分别为35.34±4.72 mmHg和肌肉注射吗啡组的31.3±3.21 mmHg。
与肌肉注射吗啡相比，硬膜外注射吗啡在质量上提供更好的镇痛效果，因为其镇痛作用更深、持续时间更长且脊髓上抑制作用更小。
