Grace D, Fee J P
Queen's University of Belfast, Department of Anaesthetics, Northern Ireland.
Anesth Analg. 1996 Nov;83(5):1055-9. doi: 10.1097/00000539-199611000-00027.
Postoperative analgesia was assessed after intrathecal administration of morphine-6-glucuronide (M6G) 100 micrograms and 125 micrograms in 75 patients undergoing total hip replacement. Analgesia was excellent and was similar to that obtained after intrathecal administration of morphine sulfate 500 micrograms. Visual analog pain scores recorded postoperatively were low (median = 0) and were similar in all three groups. However, at 6 and 10 h after operation significantly more patients in the M6G 125 group recorded pain as 0 compared with patients in the morphine group (P < 0.04, P < 0.01) and significantly more patients in the M6G 100 group recorded pain as 0 at 24 h after operation compared with patients in the morphine group (P < 0.04). Postoperative meperidine consumption using a patient-controlled system was also similar in each of the three treatment groups. Nausea and emesis occurred frequently in all groups; morphine (nausea 88%, vomiting 76%), M6G 100 micrograms (nausea 76%, vomiting 64%), and M6G 125 micrograms (nausea 88%, vomiting 60%). Respiratory depression occurred in two and three patients, respectively, in the M6G 100-microgram and 125-microgram groups but did not occur in any patient who received morphine sulfate. The lack of statistical significance in the difference in incidence of respiratory depression between the groups may represent a type II error. However, the risk of late respiratory depression developing after administration of any intrathecal opioid necessitates careful postoperative observation of patients. As M6G is a potent intrathecal analgesic further investigation of this drug using small doses may be useful.
在75例接受全髋关节置换术的患者中，鞘内注射100微克和125微克吗啡-6-葡萄糖醛酸苷（M6G）后评估术后镇痛效果。镇痛效果极佳，与鞘内注射500微克硫酸吗啡后的效果相似。术后记录的视觉模拟疼痛评分较低（中位数 = 0），且三组相似。然而，术后6小时和10小时，M6G 125微克组记录疼痛为0的患者明显多于吗啡组（P < 0.04，P < 0.01）；术后24小时，M6G 100微克组记录疼痛为0的患者明显多于吗啡组（P < 0.04）。三个治疗组中使用患者自控系统的术后哌替啶消耗量也相似。所有组中恶心和呕吐均频繁发生；吗啡组（恶心88%，呕吐76%）、M6G 100微克组（恶心76%，呕吐64%）和M6G 125微克组（恶心88%，呕吐60%）。M6G 100微克组和125微克组分别有2例和3例患者发生呼吸抑制，而接受硫酸吗啡的患者中无一例发生。各组间呼吸抑制发生率差异无统计学意义可能代表Ⅱ类错误。然而，任何鞘内阿片类药物给药后发生迟发性呼吸抑制的风险都需要对患者进行仔细的术后观察。由于M6G是一种有效的鞘内镇痛药，使用小剂量对该药物进行进一步研究可能会有帮助。
