Thorén T, Wattwil M
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
Anesth Analg. 1988 Jul;67(7):687-94.
The effects of thoracic epidural analgesia on gastric emptying were evaluated in healthy fasting volunteers. In ten volunteers, 4 mg of epidural morphine were injected at the T4 level, and ten volunteers received thoracic epidural analgesia with 0.5% bupivacaine, the latter causing block of the sympathetic innervation to the stomach. Acetaminophen absorption was used as an indirect measure of the rate of gastric emptying. After establishment of the analgesia with bupivacaine, or 160 (110-185) minutes after the administration of epidural morphine, 1.5 g acetaminophen dissolved in water was ingested. Serum samples were taken at 15-minute intervals for 2 hours and serum acetaminophen concentrations were determined by an immunologic method. Control acetaminophen absorption studies without thoracic epidural analgesia were performed in all 20 subjects on another occasion. During epidural analgesia with morphine mean serum acetaminophen concentrations were lower (P less than 0.05), the maximum serum acetaminophen concentration was lower (P less than 0.01), the time taken to reach the maximum concentration was longer (P less than 0.02), and the area under the concentration time curve from 0 to 60 minutes was smaller (P less than 0.01) than in the control study. The corresponding values during epidural analgesia with bupivacaine did not differ from the control values. Four subjects with extremely delayed gastric emptying during epidural analgesia with morphine showed no delay in gastric emptying after receiving 4 mg morphine intramuscularly. Serum morphine concentrations were lower after epidural than after intramuscular morphine. In summary, 4 mg epidural morphine delayed gastric emptying. This was not a systemic effect of morphine. Thoracic epidural analgesia with bupivacaine had no influence on gastric emptying.
在健康的空腹志愿者中评估了胸段硬膜外镇痛对胃排空的影响。在10名志愿者中，于T4水平注射4毫克硬膜外吗啡，另外10名志愿者接受0.5%布比卡因胸段硬膜外镇痛，后者可阻断胃的交感神经支配。对乙酰氨基酚的吸收被用作胃排空速率的间接指标。在用布比卡因建立镇痛后，或在硬膜外注射吗啡160（110 - 185）分钟后，摄入溶解于水中的1.5克对乙酰氨基酚。每隔15分钟采集血清样本，共采集2小时，并通过免疫学法测定血清对乙酰氨基酚浓度。所有20名受试者在另一个时间点进行了无胸段硬膜外镇痛的对乙酰氨基酚吸收对照研究。在硬膜外注射吗啡镇痛期间，平均血清对乙酰氨基酚浓度较低（P < 0.05），血清对乙酰氨基酚最大浓度较低（P < 0.01），达到最大浓度所需时间较长（P < 0.02），并且0至60分钟浓度 - 时间曲线下面积较小（P < 0.01），与对照研究相比。在布比卡因硬膜外镇痛期间的相应值与对照值无差异。在硬膜外注射吗啡镇痛期间胃排空极度延迟的4名受试者在肌肉注射4毫克吗啡后胃排空未延迟。硬膜外注射吗啡后血清吗啡浓度低于肌肉注射吗啡后血清吗啡浓度。总之，4毫克硬膜外吗啡延迟了胃排空。这不是吗啡的全身作用。布比卡因胸段硬膜外镇痛对胃排空无影响。
