France J C, Jorgenson S S, Lowe T G, Dwyer A P
University of Colorado and affiliated hospitals, Denver, USA.
Spine (Phila Pa 1976). 1997 Oct 1;22(19):2272-7. doi: 10.1097/00007632-199710010-00015.
A prospective, randomized, double-blind, placebo-controlled study was undertaken to evaluate the efficacy and safety of intrathecal morphine for postoperative analgesia after posterolateral lumbar fusion.
To compare the early postoperative analgesia in patients who receive a single dose of intrathecal morphine intraoperatively with that of patients using a patient-controlled analgesia pump only.
Although intrathecal morphine is used as an analgesic in a variety of medical and surgical conditions, very little has been published on its use after posterior lumbar spine surgery. Because the thecal sac is readily available during these procedures, the addition of a single injection of morphine before wound closure can be done with technical ease. If its efficacy and safety can be verified, then it could serve as a useful adjuvant to the postoperative analgesia regimen.
Sixty-eight consecutive patients undergoing posterolateral lumbar fusion were randomly assigned to two groups. The experimental group was injected intrathecally with morphine 30 minutes before wound closure, and the control group was similarly injected with a placebo of normal saline solution. All patients were connected to an on-demand patient-controlled analgesia pump to provide any additional necessary analgesia. Their use of the patient-controlled analgesia pump was tabulated by counting the number of demands and the actual amount of morphine delivered. Additionally, a visual analog scale was used to assess pain levels at pre-established regular intervals.
The visual analog scale measurements were significantly lower for the intrathecal morphine group initially, but they surpassed those of the control group after 24 hours. Likewise, the number of patient-controlled analgesia pump demands and the amount of narcotic delivered initially were significantly lower in the experimental patients, but again reversed after the first postoperative day. The late rebound in pain and patient-controlled analgesia pump use did not reach statistical significance. There were no significant complications related to the analgesia.
Intrathecal morphine can be safe and efficacious as an early postoperative analgesic after lumbar fusion when respiratory monitoring is used.
开展了一项前瞻性、随机、双盲、安慰剂对照研究，以评估鞘内注射吗啡用于腰椎后外侧融合术后镇痛的有效性和安全性。
比较术中接受单剂量鞘内注射吗啡的患者与仅使用患者自控镇痛泵的患者术后早期的镇痛效果。
尽管鞘内注射吗啡在多种医疗和外科手术中用作镇痛药，但关于其在腰椎后路手术后的应用报道极少。由于在这些手术过程中硬脊膜囊易于触及，在伤口闭合前单次注射吗啡操作简便。如果其有效性和安全性能够得到验证，那么它可作为术后镇痛方案的一种有用辅助手段。
68例连续接受腰椎后外侧融合术的患者被随机分为两组。实验组在伤口闭合前30分钟鞘内注射吗啡，对照组同样注射生理盐水安慰剂。所有患者均连接按需患者自控镇痛泵，以提供任何额外必要的镇痛。通过计算需求次数和实际输注的吗啡量来记录他们对患者自控镇痛泵的使用情况。此外，使用视觉模拟量表在预先设定的固定时间间隔评估疼痛程度。
鞘内注射吗啡组最初的视觉模拟量表测量值显著较低，但24小时后超过了对照组。同样，实验组患者最初对患者自控镇痛泵的需求次数和麻醉剂输注量显著较低，但在术后第一天后再次逆转。疼痛和患者自控镇痛泵使用的后期反弹未达到统计学意义。与镇痛相关的并发症无显著差异。
当使用呼吸监测时，鞘内注射吗啡作为腰椎融合术后早期镇痛药是安全有效的。
