Yonemura E, Shimada M, Nakamura M, Fukushima K
Department of Anesthesiology, National Defense Medical College, Tokorozawa.
Masui. 1990 Apr;39(4):478-86.
This study was performed on fifty patients undergoing gynecological operations of lower abdomen. Their mean age and body weight were 43 +/- 5yrs and 55 +/- 8kg (mean +/- SD) respectively. All patients were given spinal anesthesia for surgery. Patients were divided into four groups of ten patients at random as follows: Group I (control) received 7.5mg of dibucaine only, Group II received 7.5mg of dibucaine with 0.05mg of buprenorphine (B), Group III received 7.5mg of dibucaine with 0.25mg of morphine (M), Group IV was the same as G-III but received 0.2mg of naloxone after operation. We observed EEG during operation and assessed intrathecal B and M for postoperative analgesic effect and side effects. EEG finding was as follows. In G-I, alpha and beta waves appeared dominantly during operation. In G-II, G-III and G-IV, EEG showed specific beta wave which is characterized with low voltage and rapid activity. This specific EEG change emerged at 10 minutes after the intrathecal injection of M in G-III and G-IV, and at 60 minutes after the intrathecal injection of B in G-II. This finding showed that intrathecal M with less lipid solubility reached more rapidly to CSF in the fourth ventricle than intrathecal B. The result suggests that the earlier respiratory depression may be caused by large doses of intrathecal M. Postoperative analgesic effect was recognized remarkably in G-II, G-III and G-IV (P less than 0.01). The duration for pain relief was 6 hrs in G-II and 12 hrs in G-III and G-IV.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究对50例行下腹部妇科手术的患者进行。她们的平均年龄和体重分别为43±5岁和55±8千克(平均值±标准差)。所有患者均接受脊髓麻醉进行手术。患者被随机分为四组,每组10例,如下:第一组(对照组)仅接受7.5毫克丁卡因,第二组接受7.5毫克丁卡因加0.05毫克丁丙诺啡(B),第三组接受7.5毫克丁卡因加0.25毫克吗啡(M),第四组与第三组相同,但术后接受0.2毫克纳洛酮。我们在手术期间观察脑电图,并评估鞘内注射丁丙诺啡和吗啡的术后镇痛效果及副作用。脑电图结果如下。在第一组中,手术期间以α波和β波为主。在第二组、第三组和第四组中,脑电图显示出特定的β波,其特征为低电压和快速活动。这种特定的脑电图变化在第三组和第四组鞘内注射吗啡后10分钟出现,在第二组鞘内注射丁丙诺啡后60分钟出现。这一发现表明,脂溶性较低的鞘内吗啡比鞘内丁丙诺啡更快到达第四脑室的脑脊液中。结果表明,大剂量鞘内注射吗啡可能导致更早出现呼吸抑制。第二组、第三组和第四组术后镇痛效果显著(P<0.01)。第二组疼痛缓解持续时间为6小时,第三组和第四组为12小时。(摘要截短至250字)