Wang J J, Ho S T, Tzeng J I
Cathay General Hospital, Taipei, Taiwan.
Reg Anesth Pain Med. 1998 Sep-Oct;23(5):479-84. doi: 10.1016/s1098-7339(98)90031-1.
Epidural morphine is accepted as an efficient means of postoperative pain management. However, development of side effects such as nausea and vomiting and pruritus has been reported. This study compared the efficacy of intravenous infusions of nalbuphine or naloxone in the prevention of epidural morphine-related side effects.
Seventy-five female patients undergoing epidural anesthesia for total hysterectomy were enrolled in a randomized, double-blind study. At the end of the surgery, all patients received epidural 3 mg morphine (every 12 hours) for postoperative pain. Meanwhile, patients in group 1 received an adjuvant intravenous infusion of nalbuphine 60 microg/kg/h, patients in group 2 received intravenous infusion of naloxone 2 microg/kg/h, and patients in group 3 received intravenous saline infusion only. A rescue analgesic of intramuscular 50 mg meperidine (every 4 hours) was available for each patient. Patients were observed for 24 hours.
All patients had adequate postoperative pain relief. However, the proportion of patients requiring rescue analgesia and the total consumption of rescue analgesic were higher in group 2 than in the other two groups. The incidence of nausea and vomiting and pruritus was higher in group 3 than in the other two groups.
We found that coadministration of either nalbuphine or naloxone with epidural morphine reduces the incidence of morphine-related side effects. However, unlike naloxone, nalbuphine did not attenuate the analgesic effect of epidural morphine.
硬膜外注射吗啡被认为是术后疼痛管理的有效手段。然而，已有报道称会出现恶心、呕吐和瘙痒等副作用。本研究比较了静脉输注纳布啡或纳洛酮预防硬膜外吗啡相关副作用的效果。
75例接受全子宫切除硬膜外麻醉的女性患者参与了一项随机双盲研究。手术结束时，所有患者均接受硬膜外注射3mg吗啡（每12小时一次）用于术后镇痛。同时，1组患者接受辅助静脉输注纳布啡60μg/kg/h，2组患者接受静脉输注纳洛酮2μg/kg/h，3组患者仅接受静脉输注生理盐水。每位患者可使用肌肉注射50mg哌替啶（每4小时一次）的补救镇痛药。对患者进行24小时观察。
所有患者术后疼痛均得到充分缓解。然而，2组中需要补救镇痛的患者比例和补救镇痛药的总消耗量高于其他两组。3组中恶心、呕吐和瘙痒的发生率高于其他两组。
我们发现，纳布啡或纳洛酮与硬膜外吗啡联合使用可降低吗啡相关副作用的发生率。然而，与纳洛酮不同，纳布啡并未减弱硬膜外吗啡的镇痛效果。
