Johnson Juliya Pearl Joseph, Arumugam Rajasekar, Karuppusami Reka, Mariappan Ramamani
Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India.
Senior Fellow in Cardiothoracic Transplant Anaesthesia, Critical Care and ECMO, North-West Heart Centre, Manchester University, NHS Foundation Trust, Manchester, United Kingdom.
J Anaesthesiol Clin Pharmacol. 2022 Oct-Dec;38(4):537-543. doi: 10.4103/joacp.JOACP_589_20. Epub 2022 Nov 29.
Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting.
This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared.
Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185-191), 189 (187-191), and 185 (183-189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group.
All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.
采用颊黏膜移植进行尿道替代成形术会带来明显疼痛，因此围手术期疼痛管理不当可能会延迟术后恢复。我们研究的目的是确定全身、硬膜外或鞘内注射吗啡镇痛对接受颊黏膜移植尿道替代成形术患者恢复质量（QoR）的影响。
这项前瞻性、双盲、随机对照试验在接受颊黏膜移植尿道替代成形术的ASA I级和II级患者中进行了2年。患者被随机分为三组，A组接受全身吗啡（0.1 mg/kg），B组接受硬膜外吗啡（3 mg），C组接受鞘内吗啡（150 μg）。术后使用40项QoR问卷比较各组之间的QoR，并比较血流动力学变化、下床活动时间、恢复经口进食时间和并发症发生率。
在招募的93例患者中，对88例患者进行了分析。三组之间每个领域的QoR评分相当。全身、硬膜外和鞘内吗啡组的总QoR评分分别为189（185 - 191）、189（187 - 191）和185（183 - 189）。此外，除了术后恶心呕吐（PONV）和瘙痒的发生率在鞘内注射组较高外，三组之间的血流动力学变化、下床活动时间和恢复经口进食时间相当。
全身吗啡（0.1 mg/kg）、硬膜外吗啡（3 mg）和鞘内吗啡（150 μg）这三种方式在尿道替代成形术后提供相似的恢复质量。然而，鞘内注射吗啡时PONV和瘙痒的发生率较高。
