Intravenous versus intraperitoneal morphine before surgery to provide postoperative pain relief
Intravenous versus intraperitoneal morphine before surgery to provide postoperative pain relief
复制标题
DOI：
10.1111/j.1399-6576.1997.tb04834.x
复制
发表时间：
1997-09-01
影响因子：
2.1
通讯作者：
Eintrei, C
中科院分区：
文献类型：
--
作者：
Kalman, SH;Jensen, AG;Eintrei, C
背景：阿片受体存在于全身的外周传入神经上。本研究的目的是比较静脉和腹腔注射吗啡对腹部大手术后疼痛、术后吗啡用量和恢复的影响，并描述吗啡在人体内的药代动力学。方法：将30例腹部大手术患者随机分为静脉注射吗啡(IV)和腹腔注射吗啡(IF)各50 mg。在视觉模拟评分上测量疼痛，并记录3天的吗啡需求量。以口服进食时间、胃肠胀气时间和住院天数为指标衡量恢复情况。结果：静脉组在术后第1小时静息(P=0.02)和咳嗽(P=0.004)的疼痛明显减轻。静脉组术后第1天补充吗啡用量较低(P=0.016)。在复苏方面没有看到重大差异。用曲线下面积(AUG)表示的前4h吗啡血药浓度相似，但静注组活性代谢物吗啡-6-葡萄糖醛酸苷浓度显著高于静脉给药组(P=0.016)，表明与静脉注射吗啡相比，腹腔注射吗啡后的药代动力学存在差异。结论：腹部大手术前腹腔注射50 mg吗啡在减轻疼痛和术后吗啡需求方面的效果不如静脉注射相同剂量的吗啡。
Background: Opioid receptors have been demonstrated on peripheral afferent nerves throughout the body. The aim of the present study was to compare the effects of intravenous and intraperitoneal administration of morphine with regard to pain, postoperative morphine requirement, and recovery after major abdominal surgery, and to describe the pharmacokinetics of intraperitoneal morphine in humans.Methods: In a double-blind manner, 30 patients scheduled for major abdominal surgery were randomized to either 50 mg of morphine intravenously (IV) or 50 mg of morphine intraperitoneally (IF) before operation. Pain was measured on a visual analogue scale and morphine requirements were registered for 3 days. Recovery was measured as time to oral intake of food, time to flatulence and days in hospital. Plasma morphine, morphine-3-glucuronide, and morphine-6-glucuronide concentrations were determined during the first 4 h after morphine administration.Results: During the first postoperative hours there was less pain at rest (P=0.02) and on coughing (P=0.004) in the intravenous group. The requirement of additional morphine (P=0.016) was lower in the intravenous group during the first postoperative day. No major differences in recovery were seen. The plasma concentrations of morphine measured as area under the curve (AUG) during the first 4 h were similar, but the intravenous group showed significantly higher concentrations of the active metabolite morphine-6-glucuronide, (P=0.016), indicating a difference in pharmacokinetics after intraperitoneal compared to intravenous administration of morphine.Conclusion: Intraperitoneal administration of 50 mg of morphine before major abdominal surgery is less efficient in reducing pain and postoperative morphine requirements than the same amount of morphine given intravenously.