鞘内吗啡联合连续患者自控硬膜外麻醉与鞘内吗啡单独用于剖宫产术后镇痛的比较：一项随机对照试验。
Comparison of intrathecal morphine with continuous patient-controlled epidural anesthesia versus intrathecal morphine alone for post-cesarean section analgesia: a randomized controlled trial.
机构信息
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
Department of Anesthesiology, Indiana University School of Medicine, 1130 W. Michigan Street, Fesler Hall 204, Indianapolis, IN, 46202, USA.
出版信息
BMC Anesthesiol. 2020 Jun 3;20(1):138. doi: 10.1186/s12871-020-01050-6.
BACKGROUND
Several neuraxial techniques have demonstrated effective post-cesarean section analgesia. According to previous reports, it is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. However, little is known whether adding PCEA to IM is effective or not. The aim of this study was to compare post-cesarean section analgesia between IM with PCEA and IM alone.
METHODS
Fifty patients undergoing elective cesarean section were enrolled in this prospective randomized study. Patients were randomized to one of two groups: IM group and IM + PCEA group. All patients received spinal anesthesia with 12 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 150 μg of morphine. Patients in IM + PCEA group received epidural catheterization through Th11-12 or Th12-L1 before spinal anesthesia and PCEA (basal 0.167% levobupivacaine infusion rate of 6 mL/h, bolus dose of 3 mL in lockout interval of 30 min) was commenced at the end of surgery. A numerical rating scale (NRS) at rest and on movement at 4,8,12,24,48 h after the intrathecal administration of morphine were recorded. In addition, we recorded the incidence of delayed ambulation and the number of patients who requested rescue analgesics. We examined NRS using Bonferroni's multiple comparison test following repeated measures analysis of variance; p < 0.05 was considered as statistically significant.
RESULTS
Twenty-three patients in each group were finally analyzed. Mean NRS at rest was significantly higher in IM group than in IM + PCEA group at 4 (2.7 vs 0.6), 8 (2.2 vs 0.6), and 12 h (2.5 vs 0.7), and NRS during mobilization was significantly higher in IM group than in IM + PCEA group at 4 (4.9 vs 1.5), 8 (4.8 vs 1.9), 12 (4.9 vs 2), and 24 h (5.7 vs 3.5). The number of patients who required rescue analgesics during the first 24 h was significantly higher in IM group compared to IM + PCEA group. No significant difference was observed between the groups in incidence of delayed ambulation.
CONCLUSIONS
The combined use of PCEA with IM provided better post-cesarean section analgesia compared to IM alone.
TRIAL REGISTRATION
UMIN-CTR (Registration No. UMIN000032475). Registered 6 May 2018 - Retrospectively registered.
背景
已有多种神经轴突技术被证实可有效缓解剖宫产术后疼痛。根据既往报道，相较于单独鞘内注射吗啡（intrathecal morphine，IM），无阿片类药物的患者自控硬膜外镇痛（patient-controlled epidural analgesia，PCEA）在剖宫产术后镇痛方面效果可能较差。然而，目前尚不清楚鞘内注射吗啡联合 PCEA 是否有效。本研究旨在比较 IM 联合 PCEA 与 IM 单独应用在剖宫产术后镇痛中的效果。
方法
本前瞻性随机研究共纳入 50 例行择期剖宫产术的患者。患者被随机分为两组：IM 组和 IM+PCEA 组。所有患者均接受 12 mg 0.5%布比卡因、10 μg 芬太尼和 150 μg 吗啡的蛛网膜下腔麻醉。IM+PCEA 组患者在蛛网膜下腔麻醉前通过 Th11-12 或 Th12-L1 进行硬膜外导管置管，并在手术结束时开始 PCEA（基础 0.167%左旋布比卡因输注率为 6 mL/h，锁定间隔 30 min 时推注剂量为 3 mL）。记录吗啡鞘内给药后 4、8、12、24、48 h 时静息和运动时的数字评分量表（numerical rating scale，NRS）。此外，我们还记录了延迟活动的发生率和需要补救性镇痛的患者人数。我们使用 Bonferroni 多重比较检验对重复测量方差分析后的 NRS 进行了检验；p<0.05 被认为具有统计学意义。
结果
每组最终均有 23 例患者纳入分析。与 IM+PCEA 组相比，IM 组在 4、8 和 12 h 时的静息 NRS 显著更高（2.7 比 0.6、2.2 比 0.6 和 2.5 比 0.7），在 4、8、12 和 24 h 时的运动 NRS 也显著更高（4.9 比 1.5、4.8 比 1.9、4.9 比 2 和 5.7 比 3.5）。在第 1 至 24 h 期间需要补救性镇痛的患者数量，IM 组明显多于 IM+PCEA 组。两组在延迟活动发生率方面无显著差异。
结论
与单独 IM 相比，IM 联合 PCEA 可提供更好的剖宫产术后镇痛效果。
试验注册
UMIN-CTR（注册号：UMIN000032475）。2018 年 5 月 6 日注册-回顾性注册。
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