Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan City, Kyeongi Province, Korea.
Eur J Anaesthesiol. 2012 Jan;29(1):17-21. doi: 10.1097/EJA.0b013e3283476055.
Adding opioid to spinal anaesthetic provides additional analgesia during the postoperative period. The purpose of this study was to determine the dose of intrathecal hydromorphone necessary to achieve postoperative pain relief after arthroscopic knee surgery.
In a prospective, double-blinded parallel, placebo-controlled manner, 60 patients who were undergoing unilateral knee arthroscopy randomly received unilateral spinal anaesthesia with 0.5% hyperbaric bupivacaine 6 mg combined with 0.0, 2.5, 5.0 or 10.0 μg per 0.05 ml hydromorphone. Fifteen patients were assigned to receive each dose. The visual analogue pain scores (VAPSs) were measured at 30 min and 2, 4, 6, 12 and 24 h postoperatively, and the side-effects of hydromorphone were recorded.
The postoperative VAPSs at 4, 6 and 12 h for the 5 and 10 μg hydromorphone groups were significantly decreased, compared to the control group. The 2.5 μg hydromorphone group had lower VAPS only at 4 and 6 h postoperatively. Nausea was significantly increased in the 10 μg hydromorphone group (46.6%).
The analgesic effects of 5 and 10 μg intrathecal hydromorphone provided satisfactory pain relief for 12 h postoperatively and nausea increased significantly in a dose-dependent manner.
在脊髓麻醉中加入阿片类药物可在术后期间提供额外的镇痛作用。本研究的目的是确定鞘内注射氢吗啡酮的剂量，以实现关节镜膝关节手术后的术后疼痛缓解。
前瞻性、双盲、平行、安慰剂对照研究，60 例单侧膝关节镜手术患者随机接受单侧脊髓麻醉，0.5%重比重布比卡因 6mg 联合 0.0、2.5、5.0 或 10.0μg/0.05ml 氢吗啡酮。每组分配 15 例患者。在术后 30 分钟和 2、4、6、12 和 24 小时测量视觉模拟疼痛评分（VAPS），并记录氢吗啡酮的副作用。
5μg 和 10μg 氢吗啡酮组在术后 4、6 和 12 小时的术后 VAPS 明显低于对照组。2.5μg 氢吗啡酮组仅在术后 4 和 6 小时的 VAPS 较低。10μg 氢吗啡酮组恶心的发生率显著增加（46.6%）。
鞘内注射 5μg 和 10μg 氢吗啡酮可提供令人满意的 12 小时术后镇痛效果，且恶心的发生率呈剂量依赖性增加。
