Rauck R L, Raj P P, Knarr D C, Denson D D, Speight K L
Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
Reg Anesth. 1994 Sep-Oct;19(5):316-24.
To compare the effectiveness and side effects of epidural morphine sulfate (MSO4), delivered by continual infusion or intermittent bolus.
Thirty patients undergoing upper abdominal surgery were randomized into two equal groups to receive MSO4 through a thoracic epidural catheter by one of two methods. Group 1 patients received an initial bolus of morphine (0.07 mg/kg) at the end of surgery, followed by injections of 2-5 mg morphine into the epidural catheter on demand. Patients in group 2 received an initial bolus of morphine (0.03 mg/kg) during surgical peritoneal closure and were immediately started on an infusion of 0.01% morphine at 5 mL/hour (0.5 mg/hour). The infusion dose was titrated from 0.2 to 1.0 mg/hour, dependent on side effects. Outcome measurements included pulmonary function studies, arterial blood gases, morphine plasma levels, pain relief scores, global evaluations, and side effects.
No difference existed between groups in forced vital capacity, forced expiratory volume in 1 second, or in arterial blood gas measurements. Side effects were similar in both groups. Respiratory depression was not seen in either group. Group 2 reported significantly better analgesia than group 1 on postoperative days 1 and 2 (P < .01). Peak plasma morphine levels for group 1 were significantly higher than the steady state plasma morphine levels for group 2 (P < .05).
Continuous epidural infusion provides better analgesia without increased side effects for postoperative pain when compared with an intermittent (or demand) bolus technique.
比较持续输注或间断推注硬膜外硫酸吗啡（MSO4）的有效性及副作用。
30例接受上腹部手术的患者被随机分为两组，每组人数相等，通过两种方法之一经胸段硬膜外导管接受MSO4。第1组患者在手术结束时接受初始剂量吗啡推注（0.07 mg/kg），随后根据需要向硬膜外导管内注射2 - 5 mg吗啡。第2组患者在手术关闭腹膜时接受初始剂量吗啡推注（0.03 mg/kg），并立即开始以5 mL/小时（0.5 mg/小时）的速度输注0.01%吗啡。输注剂量根据副作用情况从0.2调整至1.0 mg/小时。观察指标包括肺功能研究、动脉血气分析、吗啡血浆水平、疼痛缓解评分、总体评估及副作用。
两组患者在用力肺活量、第1秒用力呼气量或动脉血气测量方面无差异。两组副作用相似。两组均未出现呼吸抑制。第2组在术后第1天和第2天的镇痛效果明显优于第1组（P < 0.01）。第1组的血浆吗啡峰值水平显著高于第2组的稳态血浆吗啡水平（P < 0.05）。
与间断（按需）推注技术相比，持续硬膜外输注用于术后镇痛效果更佳且不增加副作用。
