Rawal N, Möllefors K, Axelsson K, Lingårdh G, Widman B
Anesth Analg. 1983 Jul;62(7):641-7.
Urinary retention after epidural morphine is a distressing and troublesome complication. This study was undertaken to determine the effects of morphine (epidural, intramuscular, and intravenous) on urinary bladder function and possible reversal by naloxone. Thirty male volunteers (aged 20-28 years) were studied; the doses studied were 2, 4, and 10 mg of epidural morphine, 10 mg intramuscular morphine, and 10 mg intravenous morphine. The urodynamic study consisted of measurements of urine flow rate, strength of detrusor contraction, bladder capacity, and urethral pressure. Irrespective of dose, all subjects receiving epidural morphine showed marked relaxation of the detrusor shortly after injection. There was a corresponding increase in the maximal bladder capacity leading to urinary retention. These effects lasted an average of 14-16 h. Urethral pressures remained unchanged. Urodynamic changes after intramuscular and intravenous morphine were minimal. Treatment using a single intravenous injection of 0.8 mg naloxone promptly reversed the effects of epidural morphine on the bladder. Prevention of urinary retention was achieved with an intravenous infusion of naloxone started before administration of epidural morphine. The possible mechanisms of urinary retention following epidural opiates are discussed.
硬膜外注射吗啡后发生尿潴留是一种令人痛苦且棘手的并发症。本研究旨在确定吗啡（硬膜外、肌肉注射和静脉注射）对膀胱功能的影响以及纳洛酮可能的逆转作用。对30名年龄在20至28岁的男性志愿者进行了研究；研究的剂量分别为2毫克、4毫克和10毫克的硬膜外吗啡、10毫克肌肉注射吗啡以及10毫克静脉注射吗啡。尿动力学研究包括测量尿流率、逼尿肌收缩强度、膀胱容量和尿道压力。无论剂量如何，所有接受硬膜外吗啡注射的受试者在注射后不久都表现出逼尿肌明显松弛。最大膀胱容量相应增加，导致尿潴留。这些效应平均持续14至16小时。尿道压力保持不变。肌肉注射和静脉注射吗啡后的尿动力学变化很小。单次静脉注射0.8毫克纳洛酮可迅速逆转硬膜外吗啡对膀胱的作用。在硬膜外吗啡给药前开始静脉输注纳洛酮可预防尿潴留。文中讨论了硬膜外使用阿片类药物后发生尿潴留的可能机制。
