Chung J H, Sinatra R S, Sevarino F B, Fermo L
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06520-8051, USA.
Reg Anesth. 1997 Mar-Apr;22(2):119-24. doi: 10.1016/s1098-7339(06)80029-5.
Low-dose subarachnoid morphine provides effective perioperative analgesia but may be associated with a transient period of inadequate pain relief between the regression of local anesthetic block and the onset of morphine's analgesic effect. We hypothesized that this period of suboptimal analgesia could be avoided by adding meperidine, a rapid-acting, intermediate-duration opioid.
In a double-blind, randomized trial, 49 patients scheduled for elective cesarean delivery received subarachnoid 0.75% bupivacaine, 12 mg in 8.25% dextrose, with either meperidine 10 mg, morphine 0.15 mg, or meperidine 10 mg plus morphine 0.15 mg. Visual analog scale scores for pain and satisfaction were obtained at skin incision, delivery, uterine exteriorization, on arrival in the postanesthesia care unit, and 2, 4, 6, 12, and 24 hours after drug administration. Neonatal Apgar scores and adverse effects were also noted. Postoperative intravenous patient-controlled analgesia (PCA) requirements were recorded for 24 hours. The data were analyzed by chi-square analysis Fisher's exact test, the Wilcoxon rank sum test, and analysis of variance with Tukey's adjustment for multiple comparisons.
There were no significant differences in the incidence and severity of side effects, including nausea, vomiting, pruritus, and sedation. Respiratory depression was not observed. Patients treated with morphine alone were least comfortable (P < .006), expressed the lowest satisfaction scores at early observations (P < .002), and required more PCA meperidine (P < .001) than any other group. Patients treated with meperidine alone were comfortable at early observations but required the greatest total amount of PCA meperidine over the first 24 hours (P < .05). Patients in the meperidine-morphine combination group reported the lowest pain scores and highest satisfaction scores at 4-hour and 6-hour observations (P < .03) and required the least total amount of PCA meperidine.
The subarachnoid combination of meperidine-morphine provided more uniform analgesia, higher satisfaction, and a lower requirement for intravenous narcotic supplementation than either morphine or meperidine alone in patients recovering from cesarean delivery.
低剂量蛛网膜下腔吗啡可提供有效的围手术期镇痛，但在局部麻醉阻滞消退至吗啡镇痛效果起效之间可能存在短暂的镇痛不足期。我们推测，通过添加哌替啶（一种起效迅速、作用时间中等的阿片类药物）可以避免这一镇痛效果欠佳的时期。
在一项双盲、随机试验中，49例计划行择期剖宫产的患者接受蛛网膜下腔注射0.75%布比卡因（12mg溶于8.25%葡萄糖溶液中），并分别给予10mg哌替啶、0.15mg吗啡或10mg哌替啶加0.15mg吗啡。在皮肤切开、胎儿娩出、子宫取出时、进入麻醉后护理单元时以及给药后2、4、6、12和24小时，获取疼痛视觉模拟量表评分和满意度评分。记录新生儿阿氏评分及不良反应。记录术后24小时静脉自控镇痛（PCA）的用药需求。采用卡方分析、Fisher精确检验、Wilcoxon秩和检验以及经Tukey校正用于多重比较的方差分析对数据进行分析。
在包括恶心、呕吐、瘙痒和镇静等副作用的发生率和严重程度方面，各组间无显著差异。未观察到呼吸抑制。单独使用吗啡治疗的患者舒适度最低（P <.006），在早期观察中满意度评分最低（P <.002），且比其他任何组需要更多的PCA哌替啶（P <.001）。单独使用哌替啶治疗的患者在早期观察时舒适度良好，但在最初24小时内需要的PCA哌替啶总量最大（P <.05）。哌替啶 - 吗啡联合组患者在4小时和6小时观察时疼痛评分最低，满意度评分最高（P <.03），且所需的PCA哌替啶总量最少。
对于剖宫产术后恢复的患者，蛛网膜下腔注射哌替啶 - 吗啡联合用药比单独使用吗啡或哌替啶能提供更均匀的镇痛效果、更高的满意度，且对静脉补充麻醉剂的需求更低。
