Mercanoğlu Esra, Alanoğlu Zekeriyya, Ekmekçi Perihan, Demiralp Sacide, Alkiş Neslihan
MD, Diplomate of European Society of Anaesthesiology (DESA), Ankara University Medical Faculty Anesthesiology and ICU Department, Turkey.
MD, Diplomate of European Society of Anaesthesiology (DESA), Ankara University Medical Faculty Anesthesiology and ICU Department, Turkey.
Braz J Anesthesiol. 2013 Mar-Apr;63(2):213-9. doi: 10.1016/j.bjane.2012.05.003. Epub 2013 Aug 13.
The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management.
Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphine-ropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30(th) and 60(th) minutes and the 2(nd), 4(th), 6(th), 12(th), 24(th), 36(th), 48(th), and 72(nd) hour.
Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48(th) hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30(th) and 60(th) minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30(th) minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR.
Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.
本随机、双盲、前瞻性研究旨在确定静脉注射或硬膜外使用吗啡、布比卡因或罗哌卡因对开胸术后疼痛管理的有效性及副作用。
60例行择期开胸手术的患者采用密封信封技术随机分为4组。IVM组、EM组、EMB组和EMR组分别接受患者自控静脉注射吗啡、硬膜外注射吗啡、吗啡-布比卡因和吗啡-罗哌卡因。记录围手术期心率、血压、血氧饱和度以及术后静息和咳嗽时的疼痛情况、副作用和补救性镇痛需求，时间点为第30和60分钟以及第2、4、6、12、24、36、48和72小时。
研究期间EM组双氯芬酸钠需求量较低。与IVM组相比，EM组视觉模拟评分（VAS）-时间曲线下面积较低，但与EMB组和EMR组相似。与EM组相比，IVM组在第12、24、36和48小时的静息疼痛评分更高。与EMB组相比，EM组和IVM组在第30和60分钟的静息疼痛评分更高。与EMB组相比，EM组在第30分钟咳嗽时的疼痛评分更高。IVM组和EMR组之间无差异。
发现硬膜外使用吗啡比静脉注射更有效。EM组在术后后期更有效，而EMB组在早期更有效。我们得出结论，硬膜外吗啡是最有效且首选的药物。
