Haberkern C M, Lynn A M, Geiduschek J M, Nespeca M K, Jacobson L E, Bratton S L, Pomietto M
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Can J Anaesth. 1996 Dec;43(12):1203-10. doi: 10.1007/BF03013425.
To compare two doses of bolus epidural morphine with bolus iv morphine for postoperative pain after abdominal or genitourinary surgery in infants.
Eighteen infants were randomly assigned to bolus epidural morphine (0.025 mg.kg-1 or 0.050 mg.kg-1) or bolus iv morphine (0.050-0.150 mg.kg-1). Postoperative pain was assessed and analgesia provided, using a modified infant pain scale. Monitoring included continuous ECG, pulse oximetry, impedance and nasal thermistor pneumography. The CO2 response curves and serum morphine concentrations were measured postoperatively.
Postoperative analgesia was provided within five minutes by all treatment methods. Epidural groups required fewer morphine doses (3.8 +/- 0.8 for low dose [LE], 3.5 +/- 0.8 for high dose epidural [HE] vs. 6.7 +/- 1.6 for iv, P < 0.05) and less total morphine (0.11 +/- 0.04 mg.kg-1 for LE, 0.16 +/- 0.04 for HE vs 0.67 +/- 0.34 for iv, P < 0.05) on POD1. Dose changes were necessary in all groups for satisfactory pain scores. Pruritus, apnoea, and haemoglobin desaturation occurred in all groups. CO2 response curve slopes, similar preoperatively (range 36-41 ml.min-1.mmHg ETCO2-1.kg-1) were generally depressed (range, 16-27 ml.min-1.mmHg ETCO2-1.kg-1) on POD1. Serum morphine concentrations, negligible in LE (< 2 ng.ml-1), were similar in the HE and iv groups (peak 8.5 +/- 12.5 and 8.6 +/- 2.4 ng.ml-1, respectively).
Epidural and iv morphine provide infants effective postoperative analgesia, although side effects are common. Epidural morphine gives satisfactory analgesia with fewer doses (less total morphine); epidural morphine 0.025 mg.kg-1 is appropriate initially. Infants receiving epidural or iv morphine analgesia postoperatively need close observation in hospital with continuous pulse oximetry.
比较大剂量硬膜外吗啡与大剂量静脉注射吗啡用于婴儿腹部或泌尿生殖系统手术后疼痛的效果。
18名婴儿被随机分为大剂量硬膜外吗啡组（0.025mg/kg或0.050mg/kg）或大剂量静脉注射吗啡组（0.050 - 0.150mg/kg）。采用改良的婴儿疼痛量表评估术后疼痛并提供镇痛。监测包括连续心电图、脉搏血氧饱和度、阻抗和鼻热敏电阻呼吸描记法。术后测量二氧化碳反应曲线和血清吗啡浓度。
所有治疗方法均在5分钟内提供了术后镇痛。硬膜外组所需吗啡剂量较少（低剂量硬膜外组[LE]为3.8±0.8，高剂量硬膜外组[HE]为3.5±0.8，静脉注射组为6.7±1.6，P<0.05），术后第1天总吗啡用量也较少（LE组为0.11±0.04mg/kg，HE组为0.16±0.04mg/kg，静脉注射组为0.67±0.34mg/kg，P<0.05）。为达到满意的疼痛评分，所有组均需要调整剂量。所有组均出现瘙痒、呼吸暂停和血红蛋白饱和度下降。二氧化碳反应曲线斜率术前相似（范围为36 - 41ml·min⁻¹·mmHg⁻¹·ETCO₂⁻¹·kg⁻¹），术后第1天普遍降低（范围为16 - 27ml·min⁻¹·mmHg⁻¹·ETCO₂⁻¹·kg⁻¹）。血清吗啡浓度在LE组可忽略不计（<2ng/ml），HE组和静脉注射组相似（峰值分别为8.5±12.5和8.6±2.4ng/ml）。
硬膜外和静脉注射吗啡可为婴儿提供有效的术后镇痛，尽管副作用常见。硬膜外吗啡以较少剂量（总吗啡用量较少）提供了满意的镇痛效果；初始剂量0.025mg/kg的硬膜外吗啡是合适的。术后接受硬膜外或静脉注射吗啡镇痛的婴儿在医院需要通过连续脉搏血氧饱和度监测进行密切观察。
