Division of Pain Medicine, Department of Anaesthesiology, Central Education and Research Hospital, Erzurum, Turkey.
Arch Med Sci. 2011 Aug;7(4):694-9. doi: 10.5114/aoms.2011.24141. Epub 2011 Sep 2.
The aim of our study was to compare the effects of isobaric and hyperbaric bupivacaine combined with morphine or fentanyl in patients undergoing caesarean section. We assessed quality and spread of analgesia and anaesthesia, postoperative analgesic requirement and side effects.
Hundred patients with American Society of Anesthesiologists physical status (ASA) I-II, age 18 to 40 years, were randomized to 4 groups. The intrathecal solutions were isobaric bupivacaine + morphine (group A), isobaric bupivacaine + fentanyl (group B), heavy bupivacaine + + morphine (group C) and heavy bupivacaine + fentanyl (group D). Mean arterial pressure, heart rate, oxygen saturation, ephedrine consumption, analgesic requirement time and additional analgesic needs were recorded.
The 1(st) min value of mean arterial pressure was the lowest one in all groups. Heart rate decreased significantly in group A at the 10(th) min but not in the other groups. The decrease of visual analogue scale (VAS) pain scores began in the groups after the 4(th) postoperative h (p < 0.05) and the VAS value of group B at the 8(th) h was significantly higher than the other groups. The first analgesic requirement time in the postoperative period was longer in patients who had intrathecal morphine than those who had fentanyl. The duration of analgesia with isobaric bupivacaine and morphine was the longest one.
We concluded that intrathecal morphine provides a long duration of postoperative analgesia but the duration gets longer when it is combined with plain bupivacaine instead of heavy bupivacaine.
我们研究的目的是比较等比重布比卡因复合吗啡或芬太尼与重比重布比卡因复合吗啡或芬太尼用于剖宫产术的麻醉效果。我们评估了镇痛和麻醉的质量和扩散、术后镇痛需求和副作用。
100 例 ASA 分级 I-II 级、年龄 18-40 岁的患者随机分为 4 组。鞘内注射等比重布比卡因+吗啡（A 组）、等比重布比卡因+芬太尼（B 组）、重比重布比卡因+吗啡（C 组）和重比重布比卡因+芬太尼（D 组）。记录平均动脉压、心率、氧饱和度、麻黄碱用量、镇痛需求时间和其他镇痛需求。
所有组中，第 1 分钟的平均动脉压最低。A 组第 10 分钟心率明显下降，而其他组无此变化。VAS 疼痛评分在第 4 小时后开始下降（p<0.05），B 组第 8 小时的 VAS 值明显高于其他组。鞘内注射吗啡的患者首次需要镇痛的时间比注射芬太尼的患者长。等比重布比卡因和吗啡复合的镇痛时间最长。
我们得出结论，鞘内注射吗啡可提供较长时间的术后镇痛，但与等比重布比卡因相比，与普通布比卡因复合时镇痛时间延长。
