Rauch Erik
Bayfront Medical Center, St Petersburg, Florida, USA.
AANA J. 2011 Oct;79(5):427-32.
Currently, morphine and fentanyl are the most commonly used intrathecal opioids for the postoperative pain management of patients who underwent cesarean delivery. Unfortunately, the analgesic benefits of these 2 drugs tend to fall into different extremes based on lipid solubility. Intrathecal hydromorphone may provide more consistent analgesia because its lipid solubility falls between that of the other 2 opioids. A 22-year-old woman with a 39-week intrauterine pregnancy, gravida 2, para 1, came in for a scheduled second-time cesarean delivery. Her preoperative history included a morphine allergy discovered when administered intrathecally during her first cesarean delivery. Thus, in this case, preservative-free hydromorphone, 100 microg, was administered intrathecally as the opioid replacement for the spinal anesthetic. Intrathecal hydromorphone was found to have provided superior pain relief with fewer side effects in this patient, who received intrathecal morphine for the same surgery 2 years earlier. This case report supports an emerging hypothesis that intrathecal hydromorphone is not only safe but possibly more effective than other intrathecal opioids for pain management after cesarean delivery. The purpose of this case report is to encourage the development of more research regarding this use of intrathecal hydromorphone.
目前，吗啡和芬太尼是剖宫产术后患者疼痛管理中最常用的鞘内注射阿片类药物。不幸的是，这两种药物的镇痛效果因脂溶性不同而趋于两极分化。鞘内注射氢吗啡酮可能提供更稳定的镇痛效果，因为其脂溶性介于其他两种阿片类药物之间。一名22岁、孕39周、孕2产1的女性前来进行 scheduled second-time cesarean delivery（此处“scheduled second-time”疑有误，可能是“scheduled second”，意为“计划中的第二次”）剖宫产手术。她的术前病史包括在第一次剖宫产手术中鞘内注射时发现的吗啡过敏。因此，在本病例中，100微克无防腐剂氢吗啡酮被鞘内注射，作为脊髓麻醉的阿片类替代药物。与两年前因相同手术接受鞘内注射吗啡相比，发现鞘内注射氢吗啡酮在该患者中提供了更好的疼痛缓解且副作用更少。本病例报告支持了一个新出现的假设，即鞘内注射氢吗啡酮不仅安全，而且在剖宫产术后疼痛管理方面可能比其他鞘内注射阿片类药物更有效。本病例报告的目的是鼓励针对鞘内注射氢吗啡酮的这种用途开展更多研究。
