Wittels B, Glosten B, Faure E A, Moawad A H, Ismail M, Hibbard J, Senal J A, Cox S M, Blackman S C, Karl L, Thisted R A
Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA.
Anesth Analg. 1997 Sep;85(3):600-6. doi: 10.1097/00000539-199709000-00021.
Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients.
Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine.
在剖宫产术后的哺乳产妇中，与使用吗啡进行静脉自控镇痛（PCA）相比，使用哌替啶进行静脉PCA与新生儿神经行为抑制明显更多相关。单剂量硬膜外吗啡（4毫克）可降低剖宫产术后阿片类镇痛药的需求量，并可能减少或预防与PCA哌替啶相关的新生儿神经行为抑制。前瞻性地，102名足月产妇接受了硬膜外麻醉下的剖宫产，使用2%利多卡因和1:200,000肾上腺素。脐带结扎后，每位患者接受4毫克硬膜外吗啡，并被随机分配接受PCA哌替啶或PCA吗啡。初始新生儿特征包括胎龄、阿氏评分、体重和脐带血气分压。在出生后的头4天对每位新生儿进行布雷泽尔顿新生儿行为评估量表（NBAS）检查。哺乳婴儿（n = 47）根据母乳中母亲PCA使用的阿片类药物进行分组（哌替啶[n = 24]或吗啡[n = 23]）；人工喂养婴儿（n = 56）作为对照组。这三组婴儿在出生后头2天的初始特征和NBAS评分方面相当。在出生后第3天，与哌替啶组或对照组的婴儿相比，吗啡组的婴儿明显更警觉，对有生命的人类线索更有反应。在出生后第4天，与哌替啶组的婴儿相比，吗啡组的婴儿仍然明显更警觉，对有生命的人类听觉线索更有反应。产后48小时内PCA阿片类药物的平均消耗量相当（吗啡0.54毫克/千克，哌替啶4.7毫克/千克）；然而，即使使用这些小剂量，哌替啶与吗啡相比，新生儿的警觉性和反应性明显更差。吗啡是剖宫产术后哺乳产妇PCA镇痛的首选阿片类药物。
在剖宫产术后的哺乳产妇中，与使用吗啡进行患者自控镇痛相比，使用哌替啶进行静脉患者自控镇痛与更多的新生儿神经行为抑制相关。在本研究中，我们发现接触吗啡的哺乳婴儿比接触哌替啶的婴儿更警觉，对有生命的人类线索更有反应。
