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背景输注率下的“亚镇痛剂量”吗啡加低剂量 PCA 冲击控制疼痛效果更好,且与两次冲击式 PCA 方案一样安全:一项随机、双盲研究。

Morphine at "sub-analgesic" background infusion rate plus low-dose PCA bolus control pain better and is as safe as twice a bolus-only PCA regimen: a randomized, double blind study.

机构信息

Department Surgery A, and Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

出版信息

Pharmacol Res. 2012 Aug;66(2):185-91. doi: 10.1016/j.phrs.2012.03.016. Epub 2012 Apr 6.

Abstract

Morphine for postoperative pain control is commonly titrated via intravenous patient-controlled analgesia (IV-PCA). An IV morphine background infusion is rarely used. We investigated whether analgesia is effectively attained and morphine consumption is reduced if PCA titration is coadjuvated by a continuous infusion protocol. Following colorectal cancer surgery, consenting patients were randomized to receive a minimal ("sub-analgesic") dose of morphine 0.01 mg/kg/h background infusion plus a 0.01 mg/kg bolus (BI), or a 1.5mg bolus-only morphine (B0) (bolus ratio ∼1:2). Bolus lockout time was 7 min in either case. All patients received 0.1mg/kg morphine before protocol initiation, and diclofenac 75 mg intramuscularly b.i.d. during the study period, lasting 48 h. Eighty-six patients (51 males, age 26-95 years) participated in the study. The total mean morphine consumption during the 48 h was 25% lower in the BI than in the B0 group (P<0.05). Although the former applied the PCA device for boluses 19% less than the latter (P<0.05), their pain score was lower (P<0.05) most of the time, and they reported greater satisfaction (P<0.05) on a 10-scale numerical rating score. Pre- and postoperative vital signs were similar for both groups. No patient depicted hypoxemia or lapsed into deep sedation. Four BI and three B0 patients required treatment for postoperative nausea and vomiting. One BI patient had transient pruritus and one B0 69-year individual became disoriented 24h into treatment; either event subsided soon after stopping their respective regimen without the need for treatment. The main conclusions of the results are that very-low-dose background morphine infusion combined with small-dose PCA boluses may provide better pain relief, lower morphine consumption, and minimal complication rate as a 1.5mg PCA bolus-only protocol.

摘要

术后疼痛控制中常采用静脉患者自控镇痛(IV-PCA)滴定吗啡。静脉吗啡背景输注很少使用。我们研究了在 PCA 滴定辅助连续输注方案的情况下,是否可以有效达到镇痛效果并减少吗啡消耗。在结直肠癌手术后,同意参加的患者被随机分为接受最小(“亚镇痛”)剂量吗啡 0.01mg/kg/h 背景输注加 0.01mg/kg 推注(BI),或 1.5mg 推注仅吗啡(B0)(推注比约为 1:2)。两种情况下的推注锁定时间均为 7 分钟。所有患者在方案开始前均接受 0.1mg/kg 吗啡,在研究期间接受双氯芬酸 75mg 肌内注射,持续 48 小时。86 名患者(51 名男性,年龄 26-95 岁)参加了研究。在 48 小时内,BI 组的总平均吗啡消耗量比 B0 组低 25%(P<0.05)。尽管前者使用 PCA 设备进行推注的次数比后者少 19%(P<0.05),但他们的疼痛评分较低(P<0.05),大部分时间都较低,并且在 10 分数字评分量表上报告的满意度更高(P<0.05)。两组患者的术前和术后生命体征相似。没有患者出现低氧血症或陷入深度镇静。4 名 BI 患者和 3 名 B0 患者需要治疗术后恶心和呕吐。1 名 BI 患者出现短暂瘙痒,1 名 B0 组 69 岁患者在治疗 24 小时后出现定向障碍;停止各自方案后,这些事件很快消退,无需治疗。结果的主要结论是,非常低剂量的背景吗啡输注联合小剂量 PCA 推注可能提供更好的镇痛效果、更低的吗啡消耗和最低的并发症发生率,而 1.5mg PCA 推注仅方案。

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