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硬膜外注射吗啡对接受胸腰椎椎间盘突出症手术的犬术后镇痛的影响。

Effect of extradurally administered morphine on postoperative analgesia in dogs undergoing surgery for thoracolumbar intervertebral disk extrusion.

作者信息

Aprea Francesco, Cherubini Giunio B, Palus Viktor, Vettorato Enzo, Corletto Federico

机构信息

Dick White Referrals Veterinary Specialist Centre, Newmarket, Suffolk, England.

出版信息

J Am Vet Med Assoc. 2012 Sep 15;241(6):754-9. doi: 10.2460/javma.241.6.754.

Abstract

OBJECTIVE

To investigate the effect of intraoperative extradural morphine administration on postoperative analgesia in dogs undergoing thoracolumbar spinal surgery to treat disk extrusion.

DESIGN

Prospective clinical trial.

ANIMALS

26 client-owned dogs undergoing thoracolumbar spinal surgery.

PROCEDURES

Animals were randomly allocated to receive morphine (0.1 mg/kg [0.045 mg/lb], extradurally) or no treatment (control group). Following preanesthetic medication with methadone (0.25 mg/kg [0.11 mg/lb], IM), anesthesia was induced with propofol and maintained with isoflurane or sevoflurane in oxygen. Lidocaine and fentanyl were administered during surgery in both groups at fixed rates. In the morphine administration group, morphine was splashed over the dura mater immediately prior to wound closure. Postoperative analgesia was assessed for 48 hours by assessors unaware of group allocation, and methadone was administered as rescue analgesic. Demographic characteristics, urinary output, days of hospitalization, and perioperative use of analgesics were compared via a Mann-Whitney U test.

RESULTS

Demographic data were similar between groups. In the morphine administration group, 2 of 13 dogs required postoperative methadone, and in the control group, methadone was administered to 11 of 13 dogs. The total number of doses of methadone administered in the 48 hours after surgery was 28 in the control group and 3 in the morphine administration group. No adverse effects were recorded in any group.

CONCLUSIONS AND CLINICAL RELEVANCE

Intraoperative extradural morphine administration was effective in reducing postoperative analgesic requirement. Dogs undergoing thoracolumbar spinal surgery benefited from topical administration of preservative-free morphine administered directly on the dura mater as part of analgesic management.

摘要

目的

探讨术中硬膜外给予吗啡对接受胸腰椎脊柱手术治疗椎间盘突出症犬术后镇痛的效果。

设计

前瞻性临床试验。

动物

26只接受胸腰椎脊柱手术的客户自养犬。

方法

将动物随机分为两组,一组接受硬膜外注射吗啡(0.1mg/kg[0.045mg/lb]),另一组不接受治疗(对照组)。在使用美沙酮(0.25mg/kg[0.11mg/lb],肌肉注射)进行麻醉前给药后,用丙泊酚诱导麻醉,并用异氟烷或七氟烷在氧气中维持麻醉。两组在手术期间均以固定速率给予利多卡因和芬太尼。在吗啡给药组中,在伤口闭合前立即将吗啡喷洒在硬脑膜上。由不知道分组情况的评估人员对术后48小时的镇痛效果进行评估,并给予美沙酮作为补救性镇痛药。通过Mann-Whitney U检验比较两组的人口统计学特征、尿量、住院天数和围手术期镇痛药的使用情况。

结果

两组的人口统计学数据相似。在吗啡给药组中,13只犬中有2只术后需要美沙酮,而在对照组中,13只犬中有11只使用了美沙酮。术后48小时内,对照组给予美沙酮的总剂量为28剂,吗啡给药组为3剂。两组均未记录到不良反应。

结论及临床意义

术中硬膜外给予吗啡可有效减少术后镇痛需求。接受胸腰椎脊柱手术的犬从作为镇痛管理一部分的直接在硬脑膜上局部应用无防腐剂吗啡中获益。

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