Dose-response of intrathecal morphine when administered with intravenous ketorolac for post-cesarean analgesia: a two-center, prospective, randomized, blinded trial
Dose-response of intrathecal morphine when administered with intravenous ketorolac for post-cesarean analgesia: a two-center, prospective, randomized, blinded trial
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DOI：
10.1016/j.ijoa.2016.08.003
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发表时间：
2016-12-01
影响因子：
2.8
通讯作者：
Smiley, R.
中科院分区：
文献类型：
--
作者：
Berger, J. S.;Gonzalez, A.;Smiley, R.
背景：剖宫产后镇痛鞘内注射吗啡的合适剂量尚不清楚。随着常规非甾体类抗炎药的加入，所需的吗啡剂量可能大大低于十年前常见的 200-300 ug。我们进行了一项两中心、前瞻性、随机、盲法试验，对 144 名接受择期剖宫产的健康女性进行三种剂量的鞘内吗啡联合常规静脉注射酮咯酸的比较。方法：患者接受鞘内注射高压布比卡因 12 mg、芬太尼 15 μg 和随机剂量的 50、100 或 150 μg 吗啡，体积为2.2 毫升。患者在离开手术室前接受静脉注射酮咯酸 30 mg，并在研究期间（24 小时）每 6 小时静脉注射 15 mg。所有患者术后均接受患者自控静脉注射吗啡。主要终点是术后 24 小时内静脉注射吗啡的总量，使用混合模型回归进行分析。结果：剂量组（或机构）之间 24 小时内静脉注射吗啡的使用没有差异。疼痛和恶心的视觉模拟量表评分没有差异。 6小时和12小时时，100和150μg组的瘙痒症比50μg组更严重，但恶心或瘙痒治疗组之间没有差异。未发生呼吸抑制或显着镇静。结论：鞘内注射吗啡用于剖宫产后多模式镇痛的剂量反应关系表明，50μg产生的镇痛效果与100μg或150μg相似。 (C) 2016 Elsevier Ltd. 保留所有权利。
Background: The appropriate dose of intrathecal morphine for post-cesarean analgesia is unclear. With the inclusion of routine non-steroidal anti-inflammatory drugs, the required dose of morphine may be significantly less than the 200-300 ug common a decade ago. We performed a two-center, prospective, randomized, blinded trial comparing three doses of intrathecal morphine, combined with routine intravenous ketorolac, in 144 healthy women undergoing elective cesarean delivery.Methods: Patients received an intrathecal injection of hyperbaric bupivacaine 12 mg, fentanyl 15 mu g and a randomized dose of 50, 100, or 150 mu g morphine in a volume of 2.2 mL. Patients received intravenous ketorolac 30 mg before leaving the operating room and 15 mg intravenously every 6 h for the duration of the study (24 h). All received postoperative patient-controlled intravenous morphine. The primary endpoint was total intravenous morphine administered postoperatively over 24 h, analyzed using mixed model regression.Results: There were no differences between dose groups (or institutions) in intravenous morphine use over 24 h. Visual analog scale scores for pain and nausea did not differ. Pruritus was greater in the 100 and 150 mu g groups than the 50 mu g group at 6 h and 12 h, but there was no difference between groups in nausea or pruritus treatments. Respiratory depression or significant sedation did not occur.Conclusion: The dose response relationship of intrathecal morphine for multimodal post-cesarean analgesia suggests that 50 mu g produces analgesia similar to that produced by either 100 mu g or 150 mu g. (C) 2016 Elsevier Ltd. All rights reserved.