蛛网膜下腔给予不同剂量的吗啡用于术后镇痛

A Comparison of 0.2 mg and 0.5 mg Intrathecal Morphine for Postoperative Analgesia after Total Hip Replacement

目的:研究蛛网膜下腔给予多大剂量的吗啡用于术后镇痛的疗效和安全性。方法:70例进行全髋置换术病人,术后随机双盲蛛网膜下腔给予0．2mg或者0．5mg吗啡用于镇痛。在术后第1个24 h有多少病人需要曲马多进行术后镇痛补救,以及曲马多总共消耗剂量和不良反应发生率。结果:0．2mg和0．5 mg剂量组术后的第1个24 h需要追加剂量病人数分别为,16(48％)和28(85％)(P=0．003);0．2 mg和0．5 mg组病人在术后需要追加曲马多的剂量分别为45．4± 24．6 mg和85．5±34．3 mg(P=0．002);在两个组中不良反应的发生率基本相似。结论:蛛网膜下腔给与0．5 mg吗啡可以产生较0．2 mg更明显的术后镇痛效果,同时不增加不良反应的发生率。

Objective： The optimal dose of intrathecal morphine for postoperative analgesia after major surgery is a matter of debate, with some uncertainty concerning the therapeutic potential and safety of intrathecal morphine in the dose range is from 0. 2 to 1.0 mg. Methods： This randomised double-blind study compared the efficacy and side-effect of 0. 2 rag and 0. 5 mg intrathecal morphine in 70 patients undergoing Hip replacement surgery. The primary endpoint was the number of patients requiring rescue analgesia （tramadol） during the first 24 h postoperatively. Secondary endpoints included consumption of trarnadol and the incidence of adverse effects. Results： Fewer patients in the 0, 5 mg group required rescue analgesia in the first 24 h than in the 0. 2 mg group F16 （48%） vs 28 （85%）, respectively; P = 0. 003]. Median tramadol consumption was lower in the 0. 5 mg group than in the 0. 2 mg group（45 ± 24rag vs 85± 34mg, respectively; P = 0. 002）. The incidence of adverse effects was similar in both groups. Conclusion： This study has demonstrated that 0. 5 mg intrathecal morphine produces better analgesia than 0. 2 mg after Hip replacement without any increase in side-effects.