Department of Anaesthesiology and Reanimation, Obstetrics and Pediatrics Training and Research Hospital, The Ministry of Health and Giresun University, Giresun, Turkey.
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
J Perianesth Nurs. 2023 Oct;38(5):717-723. doi: 10.1016/j.jopan.2022.11.015. Epub 2023 Mar 28.
The objective of this study is to compare the efficacies of 3 different intrathecal doses (80, 120, and 160 mcg) of morphine in achieving postcesarean delivery analgesia and the severity of the side effects thereof.
A prospective, randomized, double-blind study.
A total of 150 pregnant women between the ages of 18 and 40, with a gestational week >36, who were planned to have elective cesarean section were included in the study. Patients were randomized into 3 groups based on the dosages of intrathecal doses of morphine (80, 120, and 160 mcg) they will receive in addition to 10 mg 0.5% hyperbaric bupivacaine and 20 mcg fentanyl. Intravenous (IV) patient-controlled analgesia (PCA) prepared with fentanyl was administered to each patient after the surgery. Postoperative 24-hour total IV PCA-fentanyl consumption was recorded. The patients were evaluated for side effects such as pain, nausea-vomiting, pruritus, sedation score, and respiratory depression after the surgery.
PCA-fentanyl consumption was significantly higher in Group 1 compared to Group 2 and 3 (P = .047). There was no significant differences between the groups in terms of nausea-vomiting scores. The pruritus scores were significantly higher in Group 3 compared to Group 1 (P = .020). The pruritus scores were significantly higher in all groups at the postoperative 8th-hour (P = .013). Respiratory depression, which would require treatment, was not observed in any patient.
Based on the study findings, it was concluded that 120 mcg intrathecal morphine provides adequate analgesia with minimal side effects in cesarean sections.
本研究旨在比较三种不同鞘内剂量（80、120 和 160mcg）吗啡在剖宫产术后镇痛中的疗效及其副作用的严重程度。
前瞻性、随机、双盲研究。
本研究纳入了 150 名年龄在 18 至 40 岁之间、孕周>36 周的计划行择期剖宫产的孕妇。患者根据接受的鞘内剂量吗啡（80、120 和 160mcg）分为三组，同时还接受 10mg0.5%布比卡因和 20mcg 芬太尼。每位患者术后均给予芬太尼静脉（IV）自控镇痛（PCA）。记录术后 24 小时内 IV PCA-芬太尼的总消耗量。术后评估患者的疼痛、恶心呕吐、瘙痒、镇静评分和呼吸抑制等副作用。
与组 2 和组 3 相比，组 1 的 PCA-芬太尼消耗量显著更高（P=0.047）。三组间恶心呕吐评分无显著差异。与组 1 相比，组 3 的瘙痒评分显著更高（P=0.020）。所有组在术后 8 小时瘙痒评分均显著更高（P=0.013）。未观察到需要治疗的呼吸抑制。
根据研究结果，120mcg 鞘内吗啡在剖宫产术中可提供足够的镇痛效果，副作用最小。
