Bernard J M, Hommeril J L, Legendre M P, Passuti N, Pinaud M
Department of Anesthesia, Centre Hospitalier Universitaire, Hôtel-Dieu, Nantes, France.
J Clin Anesth. 1993 May-Jun;5(3):231-6. doi: 10.1016/0952-8180(93)90021-6.
To compare two different methods of postoperative analgesia after extensive spinal fusion.
Double-blind, randomized study.
University-affiliated hospital.
Twenty four adult patients undergoing scoliosis correction.
Before the end of surgery, patients received either intravenous clonidine 0.3 micrograms/kg/hr and fentanyl 25 micrograms/kg (after an hourly dose of clonidine 2.5 micrograms/kg) or intrathecal morphine 0.3 mg. A saline infusion was administered to patients receiving morphine intrathecally.
Pain and sedation scores, hemodynamic data, and blood gases were collected in the recovery room at tracheal extubation and then every 2 hours for the next 14 hours. Tracheal extubation was performed at the same time in both groups (i.e., an average of 4 hours after the analgesic regimens were started). Intrathecal morphine provided a mean score of 20 mm on a visual analog scale ranging from 0 mm (no pain) to 100 mm (severe pain), but it resulted in increased PaCO2 at extubation (44 +/- 7 mmHg) and 2 hours later (42 +/- 7 mmHg). PaCO2 was greater than 50 mmHg in four patients receiving intrathecal morphine. Fentanyl-clonidine resulted in equipotent analgesia but was accompanied by sedation (sleeping but arousal by light tactile stimulation) and moderate hypotension (up to 69 +/- 9 mmHg for mean arterial pressure).
This study shows that there is a major risk of respiratory depression with a single intrathecal dose of morphine 0.3 mg to control postoperative pain after scoliosis surgery. Systemic clonidine-fentanyl may be a possible approach to the postoperative pain treatment of this surgery.
比较广泛脊柱融合术后两种不同的镇痛方法。
双盲、随机研究。
大学附属医院。
24例接受脊柱侧弯矫正的成年患者。
手术结束前，患者分别接受静脉输注可乐定0.3微克/千克/小时和芬太尼25微克/千克（每小时先给予可乐定2.5微克/千克），或鞘内注射吗啡0.3毫克。接受鞘内吗啡注射的患者同时给予生理盐水输注。
在恢复室气管拔管时以及随后14小时内每2小时收集疼痛和镇静评分、血流动力学数据及血气指标。两组同时进行气管拔管（即镇痛方案开始后平均4小时）。鞘内注射吗啡后，视觉模拟评分平均为20毫米（范围从0毫米（无疼痛）至100毫米（剧痛）），但导致拔管时（44±7毫米汞柱）及2小时后（42±7毫米汞柱）PaCO2升高。4例接受鞘内吗啡注射的患者PaCO2大于50毫米汞柱。芬太尼-可乐定产生等效镇痛效果，但伴有镇静（睡眠状态但对轻触觉刺激有反应）及中度低血压（平均动脉压降至69±9毫米汞柱）。
本研究表明，脊柱侧弯手术后单次鞘内注射0.3毫克吗啡控制术后疼痛存在呼吸抑制的重大风险。可乐定-芬太尼全身用药可能是该手术术后疼痛治疗的一种可行方法。
