Crews J C
Department of Anesthesiology/Pain Management, University of Cincinnati Medical Center, Ohio.
Crit Care Clin. 1990 Apr;6(2):315-42.
Epidural opioid analgesia has become an important therapeutic technique in the management of acute pain and has been demonstrated to be superior or equal to other parenteral opioid techniques (intramuscular, intravenous, PCA) with less associated sedation and significantly smaller doses of drugs. Beneficial therapeutic effects of epidural opioids as a result of improved analgesia include improvement in pulmonary function, modification of the endocrine-metabolic stress response, improvement in time to ambulation, decreased morbidity, and shorter hospital stay. The epidural administration of opioids is associated with potential side effects and complications, the most serious potential side effect being that of respiratory depression. This, as well as most of the other potential medication-related side effects associated with epidural opioid analgesia, is for the most part also associated with opioid analgesia provided by other routes of administration. These potential problems either occur rarely, or are controllable or preventable with appropriate patient selection and management. The potential benefits to the critical care patient as a result of the superior analgesia and reduced systemic effects associated with epidural opioid analgesia represent distinct medical and economic advantages, compared to conventional analgesic techniques.
硬膜外阿片类药物镇痛已成为急性疼痛管理中的一项重要治疗技术，并且已被证明优于或等同于其他胃肠外阿片类药物技术（肌肉注射、静脉注射、患者自控镇痛），具有较少的相关镇静作用且药物剂量显著更小。硬膜外阿片类药物因镇痛改善而产生的有益治疗效果包括肺功能改善、内分泌 - 代谢应激反应的改变、下床活动时间缩短、发病率降低以及住院时间缩短。硬膜外给予阿片类药物与潜在的副作用和并发症相关，最严重的潜在副作用是呼吸抑制。这以及与硬膜外阿片类药物镇痛相关的大多数其他潜在药物相关副作用，在很大程度上也与其他给药途径提供的阿片类药物镇痛有关。这些潜在问题要么很少发生，要么通过适当的患者选择和管理是可控或可预防的。与传统镇痛技术相比，硬膜外阿片类药物镇痛具有更好的镇痛效果和减少的全身效应，这对重症患者的潜在益处具有明显的医学和经济优势。
