Parikh Geeta P, Veena Shah R, Vora Kalpana, Parikh Beena, Joshi Anish
Middle East J Anaesthesiol. 2014 Feb;22(4):371-6.
Epidural route is preferable for postoperative pain relief in thoraco-abdominal and lower limb surgeries. We aimed to compare epidural butorphanol versus morphine for postoperative analgesia up to 24 hours in open nephrectomy surgery.
80 ASA physical status I and II adult patients were selected for this randomized double blind prospective study. A standard balanced general anesthesia technique was applied for all patients. Epidural catheter was placed in lower thoracic inter-vertebral space before the start of surgery. Injection butorphanol 0.04 mg/kg in group B (n = 40) or morphine 0.06 mg/kg in group M (n = 40) was given in a double blind manner after completion of surgery and before extubation through the epidural catheter. Patients were observed for pain relief by Visual Analogue Scale (VAS) for the next 24 hours. Dose was repeated when VAS was > 4. The onset and peak effect of pain relief, duration of analgesia of 1st dose, frequency of drug administration and side effects if any were observed.
The average onset of analgesia was 26.5 +/- 7.61 minutes with butorphanol and 62.5 +/- 13.4 minutes with morphine group which was statistically significant (p < 0.05). The mean peak effect of pain relief following 1st dose was 173 +/- 51.25 minutes with butorphanol and 251 +/- 52.32 minutes with morphine group. The duration of pain relief after 1st dose was statistically significant and was 339.13 +/- 79.57 minutes in group B and 709.75 +/- 72.12 minutes in group M which was gradually increased on repeated dosing in group B while it was almost same in Group M. Number of doses required in 24 hours was significantly higher (p < 0.05) in butorphanol group than morphine group. Somnolence was the main side effect in group B while pruritus was the main side effect with group M.
Epidural butorphanol appears to provide safer and faster postoperative analgesia without much untoward effects but its analgesic action is short so more repeated doses are required than morphine via epidural catheter up to 24 hours.
硬膜外途径对于胸腹部和下肢手术的术后疼痛缓解更为可取。我们旨在比较硬膜外注射布托啡诺与吗啡在开放性肾切除术患者术后24小时内的镇痛效果。
选取80例ASA身体状况为I级和II级的成年患者进行这项随机双盲前瞻性研究。所有患者均采用标准的平衡全身麻醉技术。在手术开始前于下胸段椎间隙置入硬膜外导管。手术结束后、拔管前，以双盲方式通过硬膜外导管给B组（n = 40）注射0.04 mg/kg布托啡诺或给M组（n = 40）注射0.06 mg/kg吗啡。在接下来的24小时内，采用视觉模拟评分法（VAS）观察患者的疼痛缓解情况。当VAS评分> 4时重复给药。观察镇痛的起效时间和峰值效应、首剂镇痛持续时间、给药频率以及是否有副作用。
布托啡诺组镇痛的平均起效时间为26.5 +/- 7.61分钟，吗啡组为62.5 +/- 13.4分钟，差异有统计学意义（p < 0.05）。首剂后疼痛缓解的平均峰值效应，布托啡诺组为173 +/- 51.25分钟，吗啡组为251 +/- 52.32分钟。首剂后的镇痛持续时间有统计学意义，B组为339.13 +/- 79.57分钟，M组为709.75 +/- 72.12分钟，B组在重复给药时逐渐延长，而M组几乎相同。24小时内布托啡诺组所需的给药次数显著高于吗啡组（p < 0.05）。嗜睡是B组的主要副作用，而瘙痒是M组的主要副作用。
硬膜外注射布托啡诺似乎能提供更安全、起效更快的术后镇痛，且不良反应较少，但与通过硬膜外导管注射吗啡相比，其镇痛作用时间较短，在24小时内需要更多的重复给药次数。
