Carvalho Francisco Amaral Egydio de, Tenório Sérgio B
Hospital Santa Cruz, Curitiba, PR, Brazil.
Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
Braz J Anesthesiol. 2013 Nov-Dec;63(6):492-9. doi: 10.1016/j.bjane.2013.01.001. Epub 2013 Dec 5.
Analgesia after caesarean section is important because postpartum women with pain have difficulty in mobility, which undermines breastfeeding. Intrathecal morphine provides adequate and prolonged analgesia after cesarean. The aim of this study was to compare the quality of analgesia provided by two doses of intrathecal morphine and its side effects in patients undergoing cesarean section.
The study included 123 pregnant women with gestational age over 38 weeks and scheduled for cesarean section. The women were randomly allocated into two groups to receive either 50 or 100 μg of intrathecal morphine (Group 50/Group 100). All patients were intrathecally anesthetized with 12 mg of 0.5% hyperbaric bupivacaine. Patients were assessed between the 9(th) and 11(th) hour and the 22(nd) and 24(th) hour after blockade for quality of analgesia, analgesic consumption, side effects, and main cause of discomfort in the first 24 hours after surgery.
There was similarity between groups regarding anthropometric data and obstetric history. There was no statistical difference in pain intensity between groups. In both groups, pain was more intense in the first 12 hours after anesthesia (p < 0.001). Tramadol hydrochloride consumption and time to first dose were similar in both groups. Pruritus was the most common side effect, with statistically higher incidence in Group 100 (p = 0.026).
Intrathecal morphine 50 μg provides the same quality of analgesia as 100 μg, with a lower incidence of side effects.
剖宫产术后镇痛很重要，因为疼痛的产后女性行动不便，这会影响母乳喂养。鞘内注射吗啡可为剖宫产术后提供充分且持久的镇痛效果。本研究的目的是比较两种剂量鞘内注射吗啡在剖宫产患者中提供的镇痛质量及其副作用。
本研究纳入了123例孕周超过38周且计划行剖宫产的孕妇。这些女性被随机分为两组，分别接受50μg或100μg鞘内注射吗啡（50μg组/100μg组）。所有患者均接受12mg 0.5%的高压布比卡因鞘内麻醉。在阻滞术后第9至11小时以及第22至24小时评估患者的镇痛质量、镇痛药消耗量、副作用以及术后24小时内不适的主要原因。
两组在人体测量数据和产科病史方面相似。两组之间的疼痛强度无统计学差异。两组在麻醉后的前12小时疼痛均更为剧烈（p < 0.001）。两组盐酸曲马多的消耗量和首次用药时间相似。瘙痒是最常见的副作用，100μg组的发生率在统计学上更高（p = 0.026）。
50μg鞘内注射吗啡与100μg提供的镇痛质量相同，但副作用发生率更低。
