Sun Liang, Guan Shuo, Dou Dou, Feng Yi, Zhang Hong, An Haiyan
Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Front Pharmacol. 2023 Apr 6;14:1126174. doi: 10.3389/fphar.2023.1126174. eCollection 2023.
The optimal dose of epidural morphine after cesarean section (CS) still remains unknown when combined with low-concentration ropivacaine based on a continuous basal infusion (CBI) mode. The aim of this study was to assess the impact of different dose of epidural morphine plus ropivacaine on maternal outcomes. Data of parturients who received epidural analgesia for CS at a teaching hospital from March 2021 to June 2022 were retrospectively collected. Parturients were divided into two groups (RM3 group and RM6 group) according to different medication regimens of morphine. The implementation of epidural analgesia was performed with 3 mg morphine in RM3 group and 6 mg morphine in RM6 group in combination with 0.1% ropivacaine a CBI pump. The primary outcomes included pain intensity at rest and movement and the incidence of urinary retention and pruritus within postoperative 48 h. The secondary outcomes included the incidence and severity of postoperative nausea and vomiting (PONV) and pruritus, the rate of rescue analgesia and grading of motor Block. Totally, 531 parturients were eligible for the final analysis, with 428 and 103 parturients in the RM3 group and RM6 group, respectively. There were no statistically significant differences in the visual analogue scores (VAS) at rest and movement within postoperative 48 h between the two groups (all > 0.05). Compared with the RM6 group, the incidence of urinary retention was lower in the RM3 group within 48 h after CS (4.0% vs. 8.7%, = 0.044). No significant difference was found in the incidence and severity of PONV and pruritus, the rate of rescue analgesia and grading of motor block between RM3 and RM6 groups. Epidural 3 mg morphine plus 0.1% ropivacaine in a CBI mode can provide equal efficacy and have lower incidence of urinary retention compared with 6 mg morphine after CS.
基于持续基础输注（CBI）模式，剖宫产（CS）后硬膜外注射吗啡与低浓度罗哌卡因联合使用时的最佳剂量仍不清楚。本研究的目的是评估不同剂量的硬膜外吗啡联合罗哌卡因对产妇结局的影响。回顾性收集了2021年3月至2022年6月在一家教学医院接受CS硬膜外镇痛的产妇数据。根据吗啡的不同用药方案将产妇分为两组（RM3组和RM6组）。RM3组使用3mg吗啡，RM6组使用6mg吗啡，均与0.1%罗哌卡因通过CBI泵联合进行硬膜外镇痛。主要结局包括静息和活动时的疼痛强度以及术后48小时内尿潴留和瘙痒的发生率。次要结局包括术后恶心呕吐（PONV）和瘙痒的发生率及严重程度、补救镇痛率和运动阻滞分级。共有531名产妇符合最终分析条件，RM3组和RM6组分别有428名和103名产妇。两组术后48小时内静息和活动时的视觉模拟评分（VAS）无统计学显著差异（均P>0.05）。与RM6组相比，RM3组CS后48小时内尿潴留的发生率较低（4.0%对8.7%，P=0.044）。RM3组和RM6组在PONV和瘙痒的发生率及严重程度、补救镇痛率和运动阻滞分级方面无显著差异。CS后，CBI模式下硬膜外注射3mg吗啡加0.1%罗哌卡因与6mg吗啡相比，可提供同等疗效且尿潴留发生率更低。
