低剂量吗啡硬膜外单次注射联合布托啡诺鼻喷剂用于腹式子宫切除术后镇痛的有效性和安全性

Effectiveness and safety of epidural bolus injection of low dose morphine combined with transnasal butorphanol on postoperative analgesia in abdominal hysterectomy

目的比较术后单次硬膜外注射吗啡一布托啡诺鼻喷剂联合镇痛与否对腹式子宫切除术后镇痛的有效性与安全性。方法单盲、完全随机、安慰剂对照研究择期ASAI-Ⅱ级行腹式子宫切除术的患者50例，分为A、B两组（n=25）：均在k硬膜外麻醉下进行手术，关腹前A组接受单次硬膜外注射吗啡0．5mg（4m1），鼻喷与B组等剂量的生理盐水（0．1ml，q4h）作安慰剂镇痛；B组于关腹前接受单次硬膜外注射吗啡0．5mg（4m1）与鼻喷剂（布托啡诺1mg～0．1ml，q4h）联合镇痛。记录视觉模拟评分法（visual analoguescale，VAS）和Remesay镇静评分，观察血压、脉搏、呼吸、血氧饱和度（SpO2）和有无延迟性呼吸抑制、恶心、呕吐、皮肤搔痒等副作用。结果B组患者术后（20h～32h）VAS评分显著低于A组：两组镇痛药时-效曲线下面积比较，AUCAⅢ=（26．2±6．5），AUCB=（14．3±5．0），差异有统计学意义（P〈0．01）；两组患者镇痛副作用差异无统计学意义。结论单次硬膜外注射吗啡0．5mg联合布托啡诺鼻喷剂（1mg，q4h）用于腹式子宫切除术后镇痛，其镇痛效果确切、术后镇痛管理容易，适合在基层医院使用。

Objective To compare the efficacy of epidural morphine with and without transnasal butorphanol on postoperative pain relief following abdominal hysterectomy. Methods This is A single-blind design, randomized, placebo controlled study. 50 patients （ASA IMI）undergoing total abdominal hysterectomies was conducted to group A and group B （n=25）. Following elective abdominal hysterectomy with epidural anesthesia via L2-3, group A of 25 patients received a single epidural bolus of morphine （0.5 rag） with transnasal saline as placebo analgesia （0.1 ml, q4 h）, and group B received a single epidural bolus of morphine （0.5 mg） combined with transnasal butorphanol 1 mg （ 0.1 ml, q4 h ） for postoperative analgesia. Parameters monitored were pain pulse, respiratory rate, SPO2 and side effects such as nausea, emesis, skin itching and delayed score （Visual Analogue Scale, VAS）, sedation score （Remesay sedation score, RSS）, blood pressure, respiratory depression. Results Compared with group A, the VAS scores were found to be decreased in group B significantly from 20 h to 32 h after epidural analgesia （P〈 0.O1 ）. There was a significant difference in analgesics-effect curve （AUC） （P〈 0.01 ） between two groups. The incidences of complications were equally comparable in both two groups. Conclusion Single epidural bolus of morphine 0.5 mg with regularly transnasal Butorphanol （1 mg, q4h） had a better analgesic effect than placebo analgesia, which is easier to perform in pain management and is practicable for abdominal hysterectomy in the primary hospital.