Zenz M, Piepenbrock S, Otten B, Otten G, Neuhaus R
Anaesthesist. 1981 Feb;30(2):77-82.
50 patients after abdominal surgery received peridural morphine for postoperative pain relief. At the end of operation, 2-3 mg morphine in 10-15 ml 0,9% saline were injected peridurally by a catheter, which was placed preoperatively. The injection was followed by a dissociated analgesia. Diffuse pain and wound pain were diminished. Pin prick and temperature were still perceived. Analgesia started within 2-5 min after injection and lasted 14 h in the mean (range 1-49 h). The degree of analgesia was determined by a visual analogue scoring system. The patients reported a marked pain relief. A new dose of 2 mg morphine was given on demand, when the patients felt pain again. This procedure was continued until the second postoperative day. The overall amount of morphine by peridural application was 8 mg within 3 days. Neither clinically nor by blood gas analyzes here were signs of respiratory depression. There were no severe side effects. The advantages of epidural morphine analgesia are: low dose, long duration, lack of sedation and motor block, lack of respiratory depression, tachyphylaxia and sympathetic block. No pneumonia were seen in the epidural morphine group, whereas 4 cases of pneumonia were seen in the control group (n = 50) with conventional analgetics.
50例腹部手术后患者接受硬膜外吗啡用于术后镇痛。手术结束时，通过术前放置的导管向硬膜外注入2 - 3毫克吗啡溶于10 - 15毫升0.9%盐水中，随后出现分离性镇痛。弥漫性疼痛和伤口疼痛减轻。仍能感知针刺觉和温度觉。镇痛在注射后2 - 5分钟内开始，平均持续14小时（范围1 - 49小时）。镇痛程度通过视觉模拟评分系统确定。患者报告疼痛明显缓解。当患者再次感到疼痛时，按需给予2毫克吗啡的新剂量。此过程持续至术后第二天。硬膜外给药3天内吗啡总量为8毫克。无论是临床观察还是血气分析均未发现呼吸抑制迹象。未出现严重副作用。硬膜外吗啡镇痛的优点包括：剂量低、持续时间长、无镇静和运动阻滞、无呼吸抑制、无快速耐受性和交感神经阻滞。硬膜外吗啡组未见到肺炎病例，而使用传统镇痛药的对照组（n = 50）中有4例发生肺炎。
