Tarkkila P, Törn K, Tuominen M, Lindgren L
Department of Anaesthesia, 4th Department of Surgery, Helsinki, Finland.
Acta Anaesthesiol Scand. 1995 Oct;39(7):983-6. doi: 10.1111/j.1399-6576.1995.tb04210.x.
Intrathecal morphine provides effective postoperative pain relief in major orthopaedic surgery. In use, however, is associated with unpleasant side effects like nausea and vomiting. The effect of different premedications on postoperative emetic sequelae induced by intrathecal morphine was studied in a prospective, double blind study. Sixty patients scheduled for arthroplasty surgery of the lower extremity were anaesthetized with spinal anaesthesia with a combination of isobaric bupivacaine 20 mg and morphine 0.3 mg. For premedication the patients were randomised to three groups of equal size. They received either oral diazepam (5-15 mg), oral promethazine (10 mg) or a combination of promethazine and transdermal scopolamine (1.5 mg). Sixty percent of the patients with both promethazine and transdermal scopolamine were totally free from postoperative nausea and vomiting (PONV) symptoms compared to those premedicated with diazepam (40%) or promethazine alone (30%). Promethazine together with transdermal scopolamine reduced significantly the number of patients with vomiting (to 25%) and also vomiting episodes. This combination was also more efficient in reducing the incidence of nausea (to 25%) and nausea episodes than promethazine along (P < 0.05). Combination also reduced the requests for additional pain relief (P < 0.05). PONV occurred in a majority of patients during the first 12 hours of the 24 hour study period and the need for additional analgesics thereafter. The incidence of itching (50-65%) and urinary catheterisation (55-70%) was similar in all groups. In conclusion, the combination of oral promethazine and transdermal scopolamine was most effective in reducing PONV symptoms and also reduced the need for postoperative pain treatment.
鞘内注射吗啡可为大型骨科手术提供有效的术后疼痛缓解。然而，在使用过程中，它会引发恶心和呕吐等不良反应。在一项前瞻性双盲研究中，研究了不同的术前用药对鞘内注射吗啡引起的术后呕吐后遗症的影响。60例计划进行下肢关节置换手术的患者接受了脊麻，使用了等比重布比卡因20mg和吗啡0.3mg的组合。对于术前用药，患者被随机分为三组，每组人数相等。他们分别接受口服地西泮（5 - 15mg）、口服异丙嗪（10mg）或异丙嗪与透皮东莨菪碱（1.5mg）的组合。与接受地西泮（40%）或单独接受异丙嗪（30%）术前用药的患者相比，同时接受异丙嗪和透皮东莨菪碱的患者中有60%完全没有术后恶心和呕吐（PONV）症状。异丙嗪与透皮东莨菪碱显著减少了呕吐患者的数量（降至25%）以及呕吐发作次数。这种组合在减少恶心发生率（降至25%）和恶心发作次数方面也比单独使用异丙嗪更有效（P < 0.05）。该组合还减少了额外止痛药物的需求（P < 0.05）。在24小时研究期的前12小时内，大多数患者出现了PONV，此后需要额外的镇痛药。所有组中瘙痒（50 - 65%）和导尿（55 - 70%）的发生率相似。总之，口服异丙嗪和透皮东莨菪碱的组合在减轻PONV症状方面最有效，并且还减少了术后疼痛治疗的需求。
