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一种用于治疗术后疼痛的椎管内吗啡临床应用方法。

A clinical approach to neuraxial morphine for the treatment of postoperative pain.

作者信息

Mugabure Bujedo Borja

机构信息

Department of Anesthesiology, Critical Care and Pain Medicine, Donostia University Hospital, 20014 San Sebastián, Spain ; Pain Relief Unit, Acute and Chronic Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain.

出版信息

Pain Res Treat. 2012;2012:612145. doi: 10.1155/2012/612145. Epub 2012 Jul 2.

Abstract

Opioids are considered a "gold standard" in clinical practice for the treatment of postoperative pain. The spinal administration of an opioid drug does not guarantee selective action and segmental analgesia in the spine. Evidence from experimental studies in animals indicates that bioavailability in the spinal cord biophase is negatively correlated with liposolubility, and is higher for hydrophilic opioids, such as morphine, than lipophilic opioids, such as fentanyl, sufentanil and alfentanil. Epidural morphine sulphate has proven analgesic efficacy and superiority over systemically administered morphine for improving postoperative pain. However, pain relief after a single epidural injection of morphine could last less than 24 hours. Techniques used to administered and prolong opioid epidural analgesia, can be costly and inconvenient. Moreover, complications can arise from indwelling epidural catheterization, particularly in patients receiving anticoagulants. Clinical trials have shown that epidural morphine in the form of extended-release liposome injections (EREM) gives good analgesia for a period of 48 hours, with no need for epidural catheterisation. Intrathecal morphine produces intense analgesia for up to 24 hours with a single shot, and clinical recommendation is to choose the minimum effective dose and do not exceed 300 μg to prevent the delay respiratory depression.

摘要

阿片类药物在临床实践中被视为治疗术后疼痛的“金标准”。脊髓给予阿片类药物并不能保证在脊髓中产生选择性作用和节段性镇痛。动物实验研究的证据表明,脊髓生物相中阿片类药物的生物利用度与脂溶性呈负相关,亲水性阿片类药物(如吗啡)在脊髓中的生物利用度高于脂溶性阿片类药物(如芬太尼、舒芬太尼和阿芬太尼)。硬膜外注射硫酸吗啡已被证明具有镇痛效果,且在改善术后疼痛方面优于全身给药的吗啡。然而,单次硬膜外注射吗啡后的镇痛效果可能持续不到24小时。用于实施和延长阿片类药物硬膜外镇痛的技术可能成本高昂且不方便。此外,留置硬膜外导管可能会引发并发症,尤其是在接受抗凝治疗的患者中。临床试验表明,缓释脂质体注射用硬膜外吗啡(EREM)可提供长达48小时的良好镇痛效果,且无需硬膜外导管置入。鞘内注射吗啡单次给药可产生长达24小时的强效镇痛效果,临床建议选择最低有效剂量,且不超过300μg,以防止呼吸抑制延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96cb/3395154/ec6df268d1c1/PRT2012-612145.001.jpg

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