Chaney M A, Furry P A, Fluder E M, Slogoff S
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Anesth Analg. 1997 Feb;84(2):241-8. doi: 10.1097/00000539-199702000-00002.
Aggressive control of pain during the immediate postoperative period after cardiac surgery with early tracheal extubation may decrease morbidity and mortality. This prospective, randomized, double-blinded, placebo-controlled clinical study examined the use of intrathecal morphine in patients undergoing cardiac surgery and its influence on early tracheal extubation and postoperative analgesic requirements. Patients were randomized to receive either 10 micrograms/kg of intrathecal morphine (n = 19) or intrathecal placebo (n = 21). Perioperative anesthetic management was standardized (intravenous (IV) fentanyl, 20 micrograms/kg, and IV midazolam, 10 mg) and included postoperative patient-controlled morphine analgesia. Of the patients who were tracheally extubated during the immediate postoperative period, the mean time from intensive care unit arrival to extubation was significantly prolonged in patients who received intrathecal morphine (10.9 h) when compared to patients who received intrathecal placebo (7.6 h). Three patients who received intrathecal morphine had extubation substantially delayed because of prolonged ventilatory depression. Although mean postoperative IV morphine use for 48 h was less in patients who received intrathecal morphine (42.8 mg) when compared to patients who received intrathecal placebo (55.0 mg), the difference between groups was not statistically significant. In conclusion, intrathecal morphine offers promise as a useful adjunct in controlling postoperative pain in patients after cardiac surgery. However, the optimal dose of intrathecal morphine in this setting, along with the optimal intraoperative baseline anesthetic that will provide significant analgesia, yet not delay extubation in the immediate postoperative period, remains to be elucidated.
心脏手术后即刻进行积极的疼痛控制并早期气管拔管可能会降低发病率和死亡率。这项前瞻性、随机、双盲、安慰剂对照的临床研究考察了鞘内注射吗啡在心脏手术患者中的应用及其对早期气管拔管和术后镇痛需求的影响。患者被随机分为两组，分别接受10微克/千克的鞘内吗啡（n = 19）或鞘内安慰剂（n = 21）。围手术期麻醉管理标准化（静脉注射（IV）芬太尼20微克/千克和IV咪达唑仑10毫克），并包括术后患者自控吗啡镇痛。在术后即刻进行气管拔管的患者中，与接受鞘内安慰剂的患者（7.6小时）相比，接受鞘内吗啡的患者从进入重症监护病房到拔管的平均时间显著延长（10.9小时）。三名接受鞘内吗啡的患者因通气抑制延长而拔管明显延迟。虽然与接受鞘内安慰剂的患者（55.0毫克）相比，接受鞘内吗啡的患者术后48小时IV吗啡的平均用量较少（42.8毫克），但两组之间的差异无统计学意义。总之，鞘内吗啡有望作为心脏手术后患者控制术后疼痛的一种有用辅助手段。然而，在这种情况下鞘内吗啡的最佳剂量，以及能提供显著镇痛效果但又不会在术后即刻延迟拔管的最佳术中基础麻醉方法，仍有待阐明。
