Suzuki Hiroko, Kamiya Yoshinori, Fujiwara Takashi, Yoshida Takayuki, Takamatsu Misako, Sato Kazunori
Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo Ward, Niigata, Niigata 951-8510 Japan.
Department of Anesthesia, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata 940-8653 Japan.
JA Clin Rep. 2015;1(1):3. doi: 10.1186/s40981-015-0005-6. Epub 2015 Aug 27.
Analgesia after Cesarean delivery (CD) requires early ambulation to prevent thromboembolic disease and to facilitate baby care. We retrospectively reviewed anesthesia charts and medical records of patients who underwent CD to compare the efficacy of spinal anesthesia supplemented with intrathecal morphine hydrochloride (ITM) and combined spinal-epidural anesthesia followed by opioid-free epidural analgesia (CSEA-EDA).
All subjects underwent CD at Nagaoka Chuo General Hospital between February 2012 and January 2013. Patient characteristics, time to first analgesic rescue after CD, and analgesic use after CD were examined. Incidences of postural hypotension, lower extremity numbness/weakness, postoperative nausea/vomiting (PONV), and pruritus were also examined for 48 h after CD. Average time to first analgesic use after CD (ITM 25.13 ± 16.07 h, CSEA-EDA 22.42 ± 16.27 h, = 0.521) and cumulative probability of rescue analgesic use ( = 0.139 by log-rank test) were comparable between groups. However, average analgesic use within 24 h was lower in the ITM group (0.75 ± 1.05 times) than in the CSEA-EDA group (1.52 ± 1.72 times, = 0.0497). Numbness or motor weakness in lower extremities only occurred in the CSEA-EDA group, and pruritus only occurred in the ITM group.
The results of this study suggest that ITM is better than CSEA-EDA for anesthesia following CD with regard to pain control. Also, ITM would be advantageous for early ambulation following CD because of lower incidence of numbness and motor weakness in lower extremities compared to CSEA-EDA.
剖宫产术后镇痛需要早期活动以预防血栓栓塞性疾病并便于照顾婴儿。我们回顾性分析了接受剖宫产患者的麻醉记录和病历，以比较鞘内注射盐酸吗啡（ITM）辅助的脊髓麻醉与腰麻-硬膜外联合麻醉后无阿片类药物硬膜外镇痛（CSEA-EDA）的效果。
所有受试者于2012年2月至2013年1月在长冈中央综合医院接受剖宫产。检查了患者特征、剖宫产后首次使用镇痛补救药物的时间以及剖宫产后的镇痛药物使用情况。还检查了剖宫产后48小时内体位性低血压、下肢麻木/无力、术后恶心/呕吐（PONV）和瘙痒的发生率。剖宫产后首次使用镇痛药物的平均时间（ITM组为25.13±16.07小时，CSEA-EDA组为22.42±16.27小时，P = 0.521）和补救性镇痛药物使用的累积概率（对数秩检验P = 0.139）在两组之间具有可比性。然而，ITM组24小时内的平均镇痛药物使用次数（0.75±1.05次）低于CSEA-EDA组（1.52±1.72次；P = 0.0497）。下肢麻木或运动无力仅发生在CSEA-EDA组，而瘙痒仅发生在ITM组。
本研究结果表明，在剖宫产麻醉的疼痛控制方面，ITM优于CSEA-EDA。此外，与CSEA-EDA相比，ITM因下肢麻木和运动无力的发生率较低，对剖宫产后的早期活动有利。
