Dougherty T B, Baysinger C L, Henenberger J C, Gooding D J
Department of Surgery/Anesthesiology, University of South Carolina School of Medicine, Columbia 29203.
Anesth Analg. 1989 Mar;68(3):318-22.
The efficacy of epidural hydromorphone alone or in combination with epinephrine for postoperative analgesia was evaluated in 30 healthy women who underwent cesarean delivery with epidural anesthesia. They were assigned randomly to receive either 1.5 mg hydromorphone alone (N = 15) or 1.5 mg hydromorphone with 1/200,000 epinephrine (N = 15). Duration of analgesia (mean +/- SD) was 24.3 +/- 9.4 hours after the epidural injection of hydromorphone plus epinephrine. This was significantly greater (p less than 0.01) than the duration of 18.2 +/- 5.9 hours after the same dose of plain hydromorphone. Analgesia was more rapid in onset and significantly better at the 0.5, 1, 3, and 12 hours postoperatively in the hydromorphone-epinephrine group. Side effects including pruritus (73%), nausea (20%), and vomiting (15%) were of similar frequency with and without epinephrine. Although mean venous PCO2 (PvCO2) levels three and six hours after the hydromorphone-epinephrine dose were elevated significantly over the pre-drug PvCO2 levels, no respiratory depression was detected by an apnea monitor to which all patients were connected. The addition of epinephrine to epidural hydromorphone hastened onset and prolonged the duration of analgesia after cesarean section.
在30例接受硬膜外麻醉剖宫产的健康女性中，评估了单独使用硬膜外氢吗啡酮或联合肾上腺素用于术后镇痛的效果。她们被随机分配接受单独1.5mg氢吗啡酮（N = 15）或1.5mg氢吗啡酮加1/200,000肾上腺素（N = 15）。硬膜外注射氢吗啡酮加肾上腺素后镇痛持续时间（平均值±标准差）为24.3±9.4小时。这显著长于（p＜0.01）相同剂量单纯氢吗啡酮后的18.2±5.9小时。在术后0.5、1、3和12小时，氢吗啡酮-肾上腺素组的镇痛起效更快且显著更好。有或无肾上腺素时，包括瘙痒（73%）、恶心（20%）和呕吐（15%）在内的副作用发生频率相似。尽管氢吗啡酮-肾上腺素给药后3小时和6小时的平均静脉血二氧化碳分压（PvCO2）水平显著高于给药前的PvCO2水平，但连接所有患者的呼吸暂停监测仪未检测到呼吸抑制。硬膜外氢吗啡酮中加入肾上腺素可加快剖宫产术后镇痛的起效并延长其持续时间。
