Milon D, Sicsic J C, Robin M, Cressy M L
Département d'Anesthésie-Réanimation, Hôpital Sud, Rennes.
Cah Anesthesiol. 1996;44(3):241-44.
Epidural opioids for caesarean section are routinely used by many anaesthesists. Combined epidural injection of a local anaesthetic and an opioid provides a more rapid onset of profound analgesia. No side effects are observed in either the mother or the neonate with epidural "microdoses" of sufentanil or fentanyl, but the postoperative analgesia is of short duration. Combined intrathecal injection on 0.1-0.2 mg morphine and 0.5% hyperbaric bupivacaine provides a better intra- and postoperative analgesia. Opiates used during anaesthesia in toxemic women before delivery imply strict subsequent paediatric care. Good postoperative analgesia can be obtained with intrathecal morphine or patient-controlled analgesia. Using other techniques depends on care and surveillance facilities. Opiates by spinal or intravenous route are not dangerous for breast-fed newborns.
许多麻醉医生常规使用硬膜外阿片类药物进行剖宫产。联合硬膜外注射局部麻醉药和阿片类药物可使深度镇痛起效更快。硬膜外给予“微剂量”舒芬太尼或芬太尼时，母亲和新生儿均未观察到副作用，但术后镇痛持续时间较短。鞘内联合注射0.1 - 0.2毫克吗啡和0.5%高压布比卡因可提供更好的术中及术后镇痛效果。分娩前对中毒妇女麻醉期间使用阿片类药物意味着后续需要严格的儿科护理。鞘内注射吗啡或患者自控镇痛可获得良好的术后镇痛效果。采用其他技术则取决于护理和监测设施。经脊髓或静脉途径使用阿片类药物对母乳喂养的新生儿并无危险。
