IONTOPHORETIC DELIVERY OF MORPHINE FOR POSTOPERATIVE ANALGESIA
IONTOPHORETIC DELIVERY OF MORPHINE FOR POSTOPERATIVE ANALGESIA
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DOI：
10.1016/0885-3924(92)90104-p
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发表时间：
1992-01-01
影响因子：
4.7
通讯作者：
HOFMAN, AA
中科院分区：
文献类型：
--
作者：
ASHBURN, MA;STEPHEN, RL;HOFMAN, AA
离子电渗疗法是一种离子化药物的经皮给药方法，其中带电分子被外部电场推动穿过皮肤。 这是一项前瞻性、随机、单盲研究，旨在确定离子电渗输送盐酸吗啡控制术后疼痛的有效性。 38例接受全膝关节或髋关节置换术的患者完成了本临床试验。 手术前获得知情同意书，并指导患者使用患者自控镇痛（PCA）装置。 术后，恢复室的疼痛最初通过静脉注射哌替啶控制，此后通过PCA治疗使用哌替啶，2 mg/cc，剂量为10 mg IV，停药期为15 min。必要时调整剂量，停药期保持不变。 每小时记录一次患者要求和给药剂量（mg）。 在手术后的早晨，将离子电渗装置连接到接受盐酸吗啡或乳酸林格氏溶液的患者，持续6小时。 在此期间和12小时后完成离子电渗，PCA镇痛仍然提供给患者。 用于测定吗啡水平的静脉血样在离子电渗期间每30分钟获得，然后在离子电渗之后每60分钟获得2小时。 在38名患者中，17名接受了离子导入吗啡，21名接受了离子导入乳酸林格氏液。 吗啡组在基线期使用PCA装置的次数多于对照组。 然而，在离子电渗疗法的机构和持续到离子电渗疗法完成后12小时，吗啡组使用的PCA哌替啶维持镇痛明显少于对照组（p = 0.001）。 用这种药物离子电渗治疗的患者血浆吗啡水平显示吗啡的镇痛水平，而对照组的吗啡水平实际上为零。 与PCA治疗或离子电渗疗法相关的不良反应很小。 离子电渗疗法可以全身性地输送足够高浓度的吗啡，以在接受全膝关节或髋关节置换术的患者中提供术后早期疼痛缓解。 进一步研究离子导入吗啡和其他阿片类药物用于术后和长期疼痛控制是必要的。
Iontophoresis is a method of transdermal administration of ionized drugs in which electrically charged molecules are propelled through the skin by an external electrical field. This was a prospective, randomized, single-blind study to determine the effectiveness of iontophoretically delivered morphine HCl for the control of postoperative pain. Thirty-eight patients who underwent total knee or hip replacement completed this clinical trial. Informed consent was obtained before surgery and patients were instructed on the use of a patient-controlled analgesia (PCA) device. Postoperatively, pain in the recovery room was initially controlled with IV meperidine, and thereafter with PCA therapy using meperidine, 2 mg/cc, with a dose of 10 mg IV and a lack-out period of 15 min. The dose was adjusted as necessary and the lock-out period remained the same. The number of patient requests and the dose (mg) administered was recorded hourly. On the morning following surgery, iontophoresis devices were attached for 6 hr to patients who received either morphine HCl or lactated ringers solution. During this period and for 12 hr following completion of iontophoresis, PCA analgesia remained available to patients. Venous blood samples for determination of morphine levels were obtained every 30 min during iontophoresis, then every 60 min for 2 hr following iontophoresis. Of the 38 patients, 17 received iontophoresed morphine, and 21 received iontophoresed lactated ringers. The morphine group utilized the PCA device more than the control group during the baseline period. However, following the institution of iontophoresis and continuing up to 12 hr following completion of iontophoresis, the morphine group used significantly less PCA meperidine to maintain analgesia than the control group (p = 0.001). Plasma morphine levels in patients iontophoresed with this drug revealed analgesic levels of morphine, whereas, those of control subjects were effectively zero. Adverse effects related to PCA therapy or iontophoresis were minimal. Iontophoresis can deliver morphine systemically in high enough concentrations to provide early postoperative pain relief in patients undergoing total knee or hip replacements. Further investigation into iontophoretically delivered morphine and other opioids for postoperative and long-term pain control is warranted.