Evron Shmuel, Samueloff Arnon, Simon Alex, Drenger Benjamin, Magora Florella
Department of Obstetrics and Gynecology, Hadassah university Hospital and Hebrew University-Hadassah Medical School, Jerusalem 91120 Israel Department of Anesthesia, Hadassah university Hospital and Hebrew University-Hadassah Medical School, Jerusalem 91120 Israel.
Pain. 1985 Oct;23(2):135-144. doi: 10.1016/0304-3959(85)90055-7.
Urinary function was assessed in 120 women after cesarean section under epidural anesthesia. Postoperative analgesia was obtained by means of epidurally administered methadone (40 patients) or morphine (40 patients). In the remaining 40 women, no narcotic drugs were given and postoperative pain was treated with intramuscular or oral non-opiate analgesics and sedatives. Both methadone and morphine provided potent postoperative pain relief. Following epidural methadone, mean urine volumes of the first two postoperative voidings were increased (543 +/- 38 ml and 571 +/- 31 ml) as compared with those after epidural morphine (219 +/- 25 ml and 218 +/- 18 ml) and with those of patients receiving non-opiate analgesics (319 +/- 28 ml and 414 +/- 30 ml). The mean time interval between the end of surgery and first voiding following methadone analgesia was shorter (336 +/- 27 min) than after morphine (582 +/- 18 min) or after non-opiate (448 +/- 28 min) analgesic drugs. Difficulty in micturition and the need for bladder catheterization were also decreased in the group with epidural methadone (2.5%) in comparison with the groups receiving morphine (57.5%) or non-opiate analgesic medicaments (12.5%). The use of epidural methadone for postoperative pain relief is advocated, both in view of its analgesic potency and of the low incidence of urinary disturbances.
对120例行硬膜外麻醉剖宫产术后的女性进行了泌尿功能评估。术后镇痛通过硬膜外给予美沙酮（40例患者）或吗啡（40例患者）实现。其余40例女性未给予麻醉药物，术后疼痛采用肌肉注射或口服非阿片类镇痛药及镇静剂治疗。美沙酮和吗啡均能有效缓解术后疼痛。硬膜外给予美沙酮后，术后首次排尿和第二次排尿的平均尿量增加（分别为543±38 ml和571±31 ml），与硬膜外给予吗啡后（分别为219±25 ml和218±18 ml）以及接受非阿片类镇痛药的患者（分别为319±28 ml和414±30 ml）相比。美沙酮镇痛后手术结束至首次排尿的平均时间间隔（336±27分钟）比吗啡（582±18分钟）或非阿片类镇痛药（448±28分钟）后更短。与接受吗啡（57.5%）或非阿片类镇痛药（12.5%）的组相比，硬膜外给予美沙酮组的排尿困难及膀胱插管需求也有所减少。鉴于其镇痛效力及泌尿功能紊乱发生率低，提倡使用硬膜外美沙酮缓解术后疼痛。
