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犬膝关节切开术后关节内注射与硬膜外注射吗啡用于镇痛的比较。

Comparison of intra-articular and epidural morphine for analgesia following stifle arthrotomy in dogs.

作者信息

Day T K, Pepper W T, Tobias T A, Flynn M F, Clarke K M

机构信息

College of Veterinary Medicine, Mississippi State University, MS 39759-9825, USA.

出版信息

Vet Surg. 1995 Nov-Dec;24(6):522-30. doi: 10.1111/j.1532-950x.1995.tb01366.x.

Abstract

We prospectively studied 18 dogs that presented for exploratory stifle arthrotomy, with or without meniscectomy, and lateral extracapsular stabilization as a result of cranial cruciate ligament rupture. Dogs were premedicated with acepromazine, induced with thiopental, and maintained with halothane in oxygen. Preoperatively, dogs were assigned to one of three groups. Group 1 (n = 6) received intra-articular morphine (0.1 mg/kg diluted in 1 mL/10 kg body weight of saline) and epidural saline (1 mL/5 kg body weight saline plus the volume of saline representing 0.1 mg/kg of morphine). Group 2 (n = 6) received intra-articular saline (1 mL/10 kg body weight of saline plus the volume of saline representing 0.1 mg/kg of morphine) and epidural saline (1 mL/5 kg body weight saline plus the volume of saline representing 0.1 mg/kg of morphine). Group 3 (n = 6) received intra-articular saline (1 mL/10 kg body weight of saline plus the volume of saline representing 0.1 mg/kg of morphine) and epidural morphine (0.1 mg/kg of morphine diluted in 1 mL/5 kg body weight saline). The efficacy of each analgesia regimen was evaluated for 6 hours postoperatively with a pain score based on subjective and objective variables. Serum cortisol and blood glucose concentrations were measured. Butorphanol was used to provide analgesia as needed based on a predetermined maximum pain score. Supplemental analgesics were required postoperatively every 2 to 3 hours for 6 hours in all dogs that did not initially receive analgesics (group 2). Pain scores were significantly lower in dogs administered morphine intra-articularly (group 1) and epidurally (group 3) at 30 minutes and 30, 120, and 360 minutes, respectively, compared with dogs that did not initially receive analgesics (group 2). One dog in group 1 and one dog in group 3 required supplemental analgesia with butorphanol. There was no difference between analgesia produced by intra-articular morphine compared with that of epidural morphine. Side effects after intra-articular or epidural morphine were not observed. Intra-articular administration of morphine can produce effective analgesia in dogs comparable with that produced by epidural administration of morphine.

摘要

我们前瞻性地研究了18只因颅交叉韧带断裂而接受探索性膝关节切开术(有或无半月板切除术)及外侧关节囊外稳定术的犬只。犬只术前用乙酰丙嗪进行预处理,用硫喷妥钠诱导麻醉,并用氟烷加氧气维持麻醉。术前,将犬只分为三组。第1组(n = 6)接受关节内吗啡(0.1 mg/kg,用1 mL/10 kg体重的生理盐水稀释)和硬膜外生理盐水(1 mL/5 kg体重的生理盐水加相当于0.1 mg/kg吗啡的生理盐水体积)。第2组(n = 6)接受关节内生理盐水(1 mL/10 kg体重的生理盐水加相当于0.1 mg/kg吗啡的生理盐水体积)和硬膜外生理盐水(1 mL/5 kg体重的生理盐水加相当于0.1 mg/kg吗啡的生理盐水体积)。第3组(n = 6)接受关节内生理盐水(1 mL/10 kg体重的生理盐水加相当于0.1 mg/kg吗啡的生理盐水体积)和硬膜外吗啡(0.1 mg/kg吗啡用1 mL/5 kg体重的生理盐水稀释)。术后6小时根据主观和客观变量用疼痛评分评估每种镇痛方案的疗效。测量血清皮质醇和血糖浓度。根据预先确定的最大疼痛评分,必要时使用布托啡诺提供镇痛。所有最初未接受镇痛的犬只(第2组)术后每2至3小时需要补充镇痛剂,持续6小时。与最初未接受镇痛的犬只(第2组)相比,关节内注射吗啡的犬只(第1组)和硬膜外注射吗啡的犬只(第3组)在30分钟以及30、120和360分钟时的疼痛评分显著更低。第1组和第3组各有1只犬需要用布托啡诺补充镇痛。关节内注射吗啡与硬膜外注射吗啡产生的镇痛效果无差异。未观察到关节内或硬膜外注射吗啡后的副作用。关节内注射吗啡在犬只中可产生与硬膜外注射吗啡相当的有效镇痛效果。

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