Pitkänen M T, Numminen M K, Tuominen M K, Rosenberg P H
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Eur J Anaesthesiol. 1997 Mar;14(2):172-7. doi: 10.1046/j.1365-2346.1997.00107.x.
Nausea and vomiting remain unpleasant side effects of intrathecal (i.t.) morphine and of the numerous therapies tried, only prophylactic intravenous (i.v.) metoclopramide has been reported to be promising. Seventy-three patients, scheduled for orthopaedic prosthesis surgery of the hip or knee were studied. They received 4 mL of plain bupivacaine and 0.3 mg of preservative-free morphine i.t. for anaesthesia. The test drugs given in a double-blind and randomized fashion, were either metoclopramide 20 mg, three times, at 6 h intervals (23 patients), ondansetron, 8 mg, twice, at 12 h intervals (25 patients), or 0.9% saline three times, at 6 h intervals (25 patients). The occurrence of nausea, vomiting and pain was followed for 24 h. The incidences of nausea and vomiting were 60% (15/25) and 56% (14/25) in the saline group, 52% (12/23) and 48% (11/23) in the metoclopramide group, and 52% (13/25) and 40% (10/25) in the ondansetron group. Incidences of severe vomiting were 24, 35 and 12% respectively. Eight patients in the saline group, seven in the metoclopramide and 10 in the ondansetron group did not need additional opioids for post-operative pain relief. We conclude that, metoclopramide and ondansetron were not better than saline in the prevention of post-operative emesis induced by intrathecal morphine.
恶心和呕吐仍然是鞘内注射吗啡令人不适的副作用，在尝试过的众多治疗方法中，仅有预防性静脉注射胃复安被报道有一定前景。对73例计划进行髋部或膝部骨科假体手术的患者进行了研究。他们接受4毫升普通布比卡因和0.3毫克无防腐剂吗啡进行鞘内麻醉。以双盲随机方式给予的受试药物，要么是胃复安20毫克，每隔6小时给药3次（23例患者），要么是昂丹司琼8毫克，每隔12小时给药2次（25例患者），要么是0.9%生理盐水，每隔6小时给药3次（25例患者）。对恶心、呕吐和疼痛的发生情况进行了24小时跟踪。生理盐水组恶心和呕吐的发生率分别为60%（15/25）和56%（14/25），胃复安组为52%（12/23）和48%（11/23），昂丹司琼组为52%（13/25）和40%（10/25）。严重呕吐的发生率分别为24%、35%和12%。生理盐水组有8例患者、胃复安组有7例患者、昂丹司琼组有10例患者术后疼痛缓解无需额外使用阿片类药物。我们得出结论，在预防鞘内吗啡引起的术后呕吐方面，胃复安和昂丹司琼并不比生理盐水效果更好。
