Chinachoti Thitima, Nilrat Pawarit, Samarnpiboonphol Piyapat
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2013 May;96(5):589-94.
Presently, in Siriraj Hospital, intrathecal morphine is routinely used in spinal anesthesia for postoperative pain control in more than 600 cases per month with doses lower than 0.3 mg. However, the incidence of side effects is high. This retrospective data review was performed to identify incidence and risk factors of postoperative nausea, vomiting, and pruritus.
One thousand three hundred six anesthetic records were analyzed for incidence of nausea, vomiting, and pruritus after spinal anesthesia with intrathecal morphine in Siriraj Hospital between October 2010 and April 2011. Data extracted were age, gender, type of operations, dosage of spinal morphine, and frequency, and severity of adverse effects (nausea, vomiting, and pruritus). Odd ratios and multiple logistic regression analysis were used.
Incidence of nausea, vomiting, and pruritus were 21.5, 14.8, and 59.5% respectively. No respiratory depression and urinary retention was reported There was statistically significant correlation in the incidence of nausea, vomiting, and pruritus with female gender, cesarean section, and intrathecal morphine dose (p < 0.001). Intrathecal morphine more than 0.2 mg resulted in an increase in severity of side effects.
The intrathecal morphine is effective in postoperative pain control. However it induces high incidence of nausea, vomiting, and pruritus. Prevention of side effects and alternatives to intrathecal morphine need further research.
目前，在诗里拉吉医院，鞘内注射吗啡常用于脊髓麻醉以控制术后疼痛，每月使用超过600例，剂量低于0.3毫克。然而，副作用的发生率很高。进行这项回顾性数据审查以确定术后恶心、呕吐和瘙痒的发生率及危险因素。
分析了2010年10月至2011年4月期间诗里拉吉医院1306例鞘内注射吗啡行脊髓麻醉后的麻醉记录，以了解恶心、呕吐和瘙痒的发生率。提取的数据包括年龄、性别、手术类型、脊髓吗啡剂量、不良反应（恶心、呕吐和瘙痒）的频率及严重程度。采用比值比和多因素逻辑回归分析。
恶心、呕吐和瘙痒的发生率分别为21.5%、14.8%和59.5%。未报告呼吸抑制和尿潴留。恶心、呕吐和瘙痒的发生率与女性、剖宫产及鞘内吗啡剂量之间存在统计学显著相关性（p<0.001）。鞘内注射吗啡超过0.2毫克会导致副作用严重程度增加。
鞘内注射吗啡在控制术后疼痛方面有效。然而，它会引起较高的恶心、呕吐和瘙痒发生率。预防副作用及鞘内注射吗啡的替代方法需要进一步研究。
