骶管预注吗啡用于痔切除术后镇痛的观察

Anterior Caudal Block with Morphine for Postoperative Analgesia of Hemorrhoidectomy

目的观察骶管内预注吗啡用于痔切除术后镇痛的效果和安全性。方法选择择期行痔切除手术60例,选用单次骶管阻滞,随机分为3组,每组20例。Ⅰ组:吗啡1.5 mg+1%利多卡因+0.375%罗哌卡因局麻药;Ⅱ组:吗啡2 mg+1%利多卡因+0.375%罗哌卡因局麻药;Ⅲ组:仅用1%利多卡因+0.375%罗哌卡因局麻药,观察3组术后4,8,16,24 h视觉模拟评分(VAS)以及恶心、呕吐、尿潴留、呼吸抑制等不良反应的发生情况。结果Ⅰ组和Ⅱ组术后4,8,16,24 h VAS评分明显低于Ⅲ组(P<0.05),Ⅱ组VAS评分又低于Ⅰ组;不良反应Ⅰ组和Ⅱ组稍低于Ⅲ组,3组比较无统计学意义(P>0.05)。结论吗啡2 mg骶管内预注用于痔切除术后镇痛效果确切,患者舒适,不良反应小。

OBJECTIVE To investigate the effect of anterior caudal block with morphine for postoperative analgesia after hemorrhoidectomy and its possible adverse effects.METHODS Sixty patients scheduled to perform hemorrhoidectomy were randomized into three groups with various dosages of morphine in combination with local anesthetics lidocaine（1%） and ropivacaine（0.375%） using single caudal anesthesia.Group Ⅰ： 1.5 mg of morphine;Group Ⅱ： 2 mg of morphine;Group Ⅲ： no morphine.Visual Analogue Scale（VAS） was evaluated to assess pain at 4,8,16,and 24 hours after surgery.Possible adverse effects such as nausea,vomit,uroschesis,respiratory depress,etc.,were also examined.RESULTS VAS scores were significantly lower in group Ⅰ and Ⅱ as compared with group Ⅲ（P0.05）.Patients in group Ⅱ had the lowest VAS among three groups.Patients in group Ⅰ and Ⅱ showed less adverse effects than those in group Ⅲ,but there was no significant difference P0.05.CONCLUSION Anterior caudal injection of 2 mg of morphine in combination of local anesthetics has significant postoperative analgesia of hemorrhoidectomy with little adverse effects.