Punja K, Graham M, Cartotto R
Department of Surgery, Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada.
J Burn Care Rehabil. 1998 Mar-Apr;19(2):142-5. doi: 10.1097/00004630-199803000-00012.
After frostbite injury, the phases of rewarming and progressive injury may cause intense pain for the patient. Although parenteral narcotic agents are the usual method of pain relief, they have well-described adverse effects such as heavy sedation, respiratory depression, and nausea and vomiting. In frostbite injury of the lower extremities, epidural blockade has the potential to provide good pain relief with fewer of those complications. However, the associated sympathetic blockade is believed by many clinicians to be of no benefit and by some to be potentially harmful. Epidural narcotics have the selective advantage of providing analgesia without sympathetic blockade. In this case report, the use of continuous epidural morphine during the first 24 hours after severe bilateral frostbite injury to the feet is described. The technique provided effective pain control, and no complications occurred. To our knowledge, use of continuous epidural morphine after frostbite injury has not been reported previously. Further use of this technique will be required to clarify its efficacy.
冻伤后，复温及进行性损伤阶段可能会给患者带来剧痛。虽然胃肠外给予麻醉剂是常用的止痛方法，但它们具有诸如深度镇静、呼吸抑制以及恶心呕吐等诸多已被充分描述的不良反应。在下肢冻伤中，硬膜外阻滞有可能在减少这些并发症的情况下提供良好的止痛效果。然而，许多临床医生认为相关的交感神经阻滞并无益处，还有一些医生认为其可能具有潜在危害。硬膜外给予麻醉性镇痛药具有选择性优势，即能提供镇痛效果而不伴有交感神经阻滞。在本病例报告中，描述了在双足严重冻伤后的最初24小时内使用持续硬膜外吗啡的情况。该技术提供了有效的疼痛控制，且未发生并发症。据我们所知，冻伤后使用持续硬膜外吗啡此前尚未见报道。需要进一步应用该技术以阐明其疗效。
