Dose-response relationship of intrathecal morphine for postcesarean analgesia
Dose-response relationship of intrathecal morphine for postcesarean analgesia
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DOI：
10.1097/00000542-199902000-00018
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发表时间：
1999-02-01
期刊：
影响因子：
8.8
通讯作者：
Alves, D
中科院分区：
文献类型：
--
作者：
Palmer, CM;Emerson, S;Alves, D
背景：本研究调查了鞘内注射吗啡用于剖宫产术后镇痛的质量和副作用的发生率和严重程度。方法：108例足月剖宫产产妇在腰麻下随机接受单次鞘内注射吗啡(0、0.025、0.05、0.075、0.1、0.2、0.3、0.4或0.5 mg)。患者自控止痛器(PGI)提供免费的额外止痛药。记录2 4h内吗啡的使用情况、不良反应的发生率和严重程度以及需要干预的情况。结果：患者自控镇痛的使用在不同组间有显著差异；对照组的自控镇痛用药量高于0.075、0.1、0.3、0.4、0.5 mg组。0.075毫克组的24小时自控镇痛吗啡使用量比对照组低45.7毫克(95%可信区间，低4.8-86.6毫克)。在0.075毫克组和0.5毫克组之间，自控镇痛吗啡的使用没有差异(95%CI，36.8毫克低，高45.0毫克)；尽管鞘内吗啡剂量增加了五倍，自控镇痛吗啡的使用保持不变。在恶心和呕吐方面，对照组和治疗组之间或治疗组之间没有差异。皮下注射吗啡的剂量越大，患者的瘙痒症状越多，需要治疗干预的次数越多(线性回归分别为P=0.001和P=0.0002)。结论：剖宫产术后镇痛剂的用量超过0.1mg时几乎没有合理的理由。为了达到最佳的镇痛效果，鞘内注射吗啡和全身阿片类药物可能是必要的。
Background: This series investigated the quality of analgesia and the incidence and severity of side effects of intrathecal morphine for post-cesarean analgesia administered over a dose range of 0.0-0.5 mg.Methods: One hundred eight term parturients undergoing cesarean delivery at term and given spinal anesthesia were randomized to receive a single dose of intrathecal morphine (0.0, 0.025, 0.05, 0.075, 0.1, 0.2, 0.3, 0.4, or 0.5 mg). A patient-controlled analgesia (PGI) device provided free access to additional analgesics. PCA morphine use, incidence and severity of side effects, and need for treatment interventions were recorded for 24 h. Data mere analyzed with analysis of variance and linear regression analysis for trends among groups.Results: Patient-controlled analgesia use differed significantly between groups; PCA use was higher in the control group than in groups receiving 0.075, 0.1, 0.3, 0.4, or 0.5 mg. Twenty-four-hour PCA morphine use was 45.7 mg lower (95% CI, 4.8-86.6 mg lower) in the 0.075-mg group than the control group. There was no difference in PCA morphine use between the 0.075- and 0.5-mg groups (95% CI, 36.8 mg lower to 45.0 mg higher); despite a fivefold increase in intrathecal morphine dose, PCA morphine use remained constant. There was no difference between control and treatment groups or among treatment groups with respect to nausea and vomiting. Pruritus and the need for treatment interventions increased in direct proportion to the dose of intrathecal morphine (linear regression, P = 0.001 and P = 0.0002, respectively).Conclusions: These data indicate there is Little justification for use of more than 0.1 mg for post-cesarean analgesia. For optimal analgesia, increase of intrathecal morphine with systemic opioids may be necessary.