Nègre I, Guéneron J P, Jamali S J, Monin S, Ecoffey C
Département d'Anesthésie-Réanimation, Université Paris Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Anesth Analg. 1994 Aug;79(2):298-302.
In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intraabdominal surgery were randomly assigned to two groups: a control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. Postoperative pain relief was achieved with intravenous (IV) boluses of morphine using a patient-controlled analgesia device. We found smaller opioid requirements in the epidural group than in the control group for intraoperative fentanyl (465 +/- 179 micrograms vs 983 +/- 682 micrograms), for postoperative morphine at 12 h (3.1 +/- 3 mg vs 21.4 +/- 13.8 mg) and 24 h (9.1 +/- 6.4 mg vs 20.6 +/- 9.8 mg), and for the cumulated needs over the 3-day postoperative period (37 +/- 24 mg vs 86 +/- 42 mg). The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 +/- 2.4 vs 3 +/- 2), at 36 h (0.3 +/- 0.6 vs 3 +/- 2.7), and at 60 h (0.1 +/- 0.3 vs 1.8 +/- 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.
在一项前瞻性双盲研究中，我们检查了术前硬膜外注射吗啡联合全身麻醉（GA）对术后3天内术中和术后镇痛需求的影响。20例计划进行大型腹部手术的患者被随机分为两组：对照组（n = 10）和硬膜外组（n = 10），硬膜外组接受在10 mL 0.9%盐水中注射5 mg无防腐剂吗啡。之后，两组均接受相同的全身麻醉。使用患者自控镇痛装置通过静脉推注吗啡实现术后疼痛缓解。我们发现硬膜外组术中芬太尼的阿片类药物需求量低于对照组（465±179微克 vs 983±682微克），术后12小时（3.1±3毫克 vs 21.4±13.8毫克）和24小时（9.1±6.4毫克 vs 20.6±9.8毫克）的吗啡需求量，以及术后3天内的累积需求量（37±24毫克 vs 86±42毫克）均低于对照组。对照组静脉注射吗啡的消耗量随时间减少（P < 0.001，r = 0.44），而在硬膜外组，3天内消耗量保持恒定且较少。术后24小时（0.65±2.4 vs 3±2）、36小时（0.3±0.6 vs 3±2.7）和60小时（0.1±0.3 vs 1.8±1.2）时，硬膜外组的最大疼痛评分显著低于对照组。这些结果表明，大型手术前单次硬膜外注射5 mg吗啡可在术中和术后至少3天缓解疼痛。
