Matsuda M, Murakawa K, Noma K, Uemura Y, Maeda S, Tashiro C
Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya.
Masui. 1998 Sep;47(9):1122-7.
In the patients receiving morphine preoperatively, it is preoperatively important to avoid withdrawal symptoms postoperatively and to suppress postoperative pain and to maintain an appropriate anesthetic depth during the operation. We experienced six patients who had been under preoperative pain control with oral and/or epidural morphine and undergone palliative operation for their cancer pain. Four of the patients were preoperatively administered with oral morphine ranging from 30 to 270 mg.day-1. One patient was given epidural morphine 10 mg.day-1. Another was with morphine 1800 mg.day-1 orally and 50 mg.day-1 epiduraly. In all cases, general anesthesia was maintained with inhalation anesthetics. Anesthetic supplementation and postoperative pain management were performed with continuous i.v. infusion of morphine (half dosage of daily oral dosage), or subcutaneous injection (one sixth dosage of daily oral morphine) while preoperative epidural morphine was continued throughout the perioperative period. We were able to manage these patients well and none of them developed withdrawal symptom or increased postoperative pain.
在术前接受吗啡治疗的患者中，避免术后出现戒断症状、抑制术后疼痛并在手术期间维持适当的麻醉深度在术前至关重要。我们遇到了6例术前通过口服和/或硬膜外给予吗啡控制疼痛并因癌痛接受姑息手术的患者。其中4例患者术前口服吗啡剂量为30至270毫克/天。1例患者接受硬膜外吗啡10毫克/天。另1例患者口服吗啡1800毫克/天，硬膜外给予50毫克/天。所有病例均采用吸入麻醉药维持全身麻醉。麻醉补充和术后疼痛管理通过持续静脉输注吗啡（每日口服剂量的一半）或皮下注射（每日口服吗啡剂量的六分之一）进行，同时术前硬膜外吗啡在围手术期全程持续使用。我们能够很好地管理这些患者，他们均未出现戒断症状或术后疼痛加剧。
