Yen David, Turner Kim, Mark David
Pain Res Manag. 2015 May-Jun;20(3):129-32. doi: 10.1155/2015/761390.
Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA).
To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.
Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.
The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.
ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.
多项关于脊柱手术后鞘内注射吗啡（ITM）的研究已发表，这些研究要么涉及儿科人群，要么使用中高剂量ITM，要么未与吗啡患者自控镇痛（PCA）联合使用。
确定低剂量ITM是否可作为PCA的有用辅助手段，用于成人择期腰椎手术后的疼痛控制。
32例患者参加了一项双盲随机对照试验，接受ITM或鞘内注射安慰剂。术后，所有患者均给予PCA泵，并在逐步降级病房观察24小时。记录以下指标：术后24小时内PCA吗啡的总消耗量；疼痛强度；瘙痒；术后4小时、8小时和24小时的恶心情况；首次下床活动时间；住院时间；以及呼吸抑制的发生情况。
ITM组PCA的总用量显著较低。ITM组的平均疼痛评分较低，在24小时内升至鞘内注射安慰剂组的水平；然而，这未达到统计学显著性。恶心、瘙痒、首次下床活动时间或住院时间方面无差异。两组均未出现呼吸抑制病例。
ITM可能是PCA的有用辅助手段，但并未缩短下床活动时间或住院时间。
