Department of Anaesthesia, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.
Center for Investigation and Research in Sleep, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.
Br J Anaesth. 2020 Nov;125(5):811-817. doi: 10.1016/j.bja.2020.07.052. Epub 2020 Sep 6.
Intrathecal morphine prolongs analgesia after surgery, but has been implicated in postoperative respiratory depression or apnoeic episodes. However, this has not been investigated in a prospective trial using respiratory polygraphy. This randomised controlled triple-blinded trial tested the hypothesis that intrathecal morphine increases sleep apnoea severity, measured using respiratory polygraphy.
Sixty subjects undergoing hip arthroplasty under spinal anaesthesia received either 15 mg isobaric bupivacaine 0.5% with 0.5 ml normal saline 0.9% (control group) or 15 mg isobaric bupivacaine 0.5% with 0.5 ml intrathecal morphine 100 μg (intrathecal morphine group). Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the apnoea-hypopnoea index in the supine position (supine AHI) on the first postoperative night. Secondary outcomes included supine AHI on the third postoperative night, oxygen desaturation index (ODI), and ventilatory frequency during the first and third postoperative nights.
On the first postoperative night, mean (95% confidence interval) values for supine AHI were 20.6 (13.9-27.3) and 21.2 (12.4-30.0) events h in the control and intrathecal morphine groups, respectively (P=0.90). There were no significant between-group differences for any of the secondary outcomes, except for a significantly higher central and mixed apnoea index preoperatively and significantly lower mean SpO on the third postoperative night in the control group.
Intrathecal morphine did not increase sleep apnoea severity when measured using respiratory polygraphy. Of note, all patients had an increased number of apnoeic episodes on the third postoperative night.
NCT02566226.
鞘内注射吗啡可延长手术后的镇痛时间，但已被认为与术后呼吸抑制或呼吸暂停发作有关。然而，这一点尚未通过使用呼吸描记法进行前瞻性试验来证实。本随机对照三盲试验旨在测试鞘内注射吗啡是否会增加睡眠呼吸暂停的严重程度，方法是使用呼吸描记法进行测量。
60 名接受脊髓麻醉下髋关节置换术的患者被随机分为两组：接受 15mg 等比重布比卡因 0.5%+0.9%生理盐水 0.5ml（对照组）或 15mg 等比重布比卡因 0.5%+100μg 鞘内吗啡（鞘内吗啡组）。术前及术后第一和第三晚进行呼吸描记法检查。主要结局是术后第一晚仰卧位时的呼吸暂停低通气指数（仰卧位 AHI）。次要结局包括术后第三晚仰卧位 AHI、氧减指数（ODI）以及第一和第三晚的呼吸频率。
术后第一晚，对照组和鞘内吗啡组的仰卧位 AHI 平均值（95%置信区间）分别为 20.6（13.9-27.3）和 21.2（12.4-30.0）事件/小时（P=0.90）。除对照组术前中央性和混合性呼吸暂停指数显著较高以及术后第三晚平均 SpO 显著较低外，两组间在其他次要结局上无显著差异。
使用呼吸描记法测量时，鞘内注射吗啡并未增加睡眠呼吸暂停的严重程度。值得注意的是，所有患者在术后第三晚的呼吸暂停次数都有所增加。
NCT02566226。
