Cardoso M M, Carvalho J C, Amaro A R, Prado A A, Cappelli E L
Hospital e Maternidade Santa Joana, São Paulo, Brazil.
Anesth Analg. 1998 Mar;86(3):538-41. doi: 10.1097/00000539-199803000-00017.
Postoperative pain control after cesarean delivery under spinal anesthesia is effectively obtained with morphine 0.1-0.3 mg intrathecally, although there may be dose-dependent side effects. We evaluated the quality of analgesia and the incidence of side effects with smaller doses of intrathecal morphine combined with intramuscular (i.m.) diclofenac. One hundred-twenty pregnant patients were allocated into six groups, which received the following treatments: Groups 1, 3, and 5 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus 75 mg of i.m. diclofenac every 8 h; Groups 2, 4, and 6 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus i.m. diclofenac on demand. Spinal anesthesia was performed with 15 mg of 0.5% hyperbaric bupivacaine. Pain scores and side effects were evaluated hourly for the first 24 h. Groups 1 and 2 had lower pain scores than Groups 3, 4, 5, and 6. However, only patients in Groups 2, 4, and 6 requested additional analgesics. Severe pruritus was more frequent in Groups 1 and 2. No patient experienced respiratory depression. We conclude that there is no advantage in using doses larger than 0.025 mg of intrathecal morphine if they are combined with systemic diclofenac.
A multimodal approach to pain control may provide good quality analgesia while reducing drug-related side effects. In this study, a very small dose of intrathecal morphine, in association with intramuscular diclofenac, proved effective for controlling pain after cesarean delivery, with a low incidence of morphine-induced pruritus.
脊髓麻醉下剖宫产术后，鞘内注射0.1 - 0.3 mg吗啡可有效控制疼痛，尽管可能存在剂量依赖性副作用。我们评估了小剂量鞘内吗啡联合肌内注射双氯芬酸时的镇痛质量和副作用发生率。120例孕妇被分为六组，接受以下治疗：第1、3和5组分别接受0.1、0.05和0.025 mg鞘内吗啡，外加每8小时肌内注射75 mg双氯芬酸；第2、4和6组分别接受0.1、0.05和0.025 mg鞘内吗啡，外加按需肌内注射双氯芬酸。采用15 mg 0.5%的高压布比卡因进行脊髓麻醉。在最初24小时内每小时评估疼痛评分和副作用。第1和2组的疼痛评分低于第3、4、5和6组。然而，只有第2、4和6组的患者要求追加镇痛药。第1和2组严重瘙痒更常见。无患者出现呼吸抑制。我们得出结论，如果鞘内吗啡与全身应用双氯芬酸联合使用，使用大于0.025 mg的剂量并无优势。
多模式疼痛控制方法可能在提供良好镇痛质量的同时减少药物相关副作用。在本研究中，极少量鞘内吗啡与肌内注射双氯芬酸联合使用，被证明对剖宫产术后疼痛控制有效，且吗啡诱发瘙痒的发生率低。
