加巴喷丁联合硬膜外吗啡对子宫全切术术后镇痛的影响

目的观察术前口服加巴喷丁联合硬膜外吗啡对子宫全切术术后镇痛的影响。方法选择在硬膜外联合腰麻下施行择期子宫全切术的患者60例，随机分为3组，每组20例。A组硬膜外镇痛药物配方为吗啡5mg加0．75％布比卡因18ml，用生理盐水配至100ml；B组硬膜外镇痛药物配方为吗啡2．5mg加0．75％布比卡因18ml，用生理盐水配至100ml，C组于术前2h口服加巴喷丁300mg，其硬膜外镇痛药物配方与B组相同。以视觉模拟评分法（VAs）评定术后疼痛程度，并记录镇静程度和副作用的发生率。结果与B组比较，A、C组于术后2、4、16、24h时VAS明显降低（P〈O．05），而A组与C组比较无统计学差异；在术后48h三组的VAS无统计学差异；在术后第1日，B、C组的镇静评分明显低于A组（P〈0．05），而术后第2日三组的镇静评分均无统计学差异。结论术前口服加巴喷丁300mg联合硬膜外吗啡对子宫全切术术后疼痛具有良好的镇痛作用，并能减少吗啡的用量和副作用。

Effect of gabapentin combined with epidural morphine analgesia on postoperative pain in patients undergoing total hysterectomy

Objective To observe the effect of preoperative oral gabapentin combined with epidural morphine analgesia on postoperative pain in the patients undergoing total hysterectomy. Methods Sixty patients scheduled for total hysterectomy under combined spinal-epidural anesthesia were randomly divided into three groups （20 per group）. The drug formulation of group A was mor- phine 5 mg plus 0.75% bupivacaine 18 ml, and of group B and C was morphine 2.5mg plus 0.75% bupivacaine 18 ml, with adding normal saline to volume 100 ml in all groups. The patients of group C received oral gabapentin 300 mg 2 h before surgery. Visual analogue scale （VAS） and sedation and the incidence of side effect were observed at the time points 2, 4, 6, 16, 24 and 48 h after surgery. Results Compared with group B, the VAS in group A and group C decreased significantly at 2, 4, 16, 24 h after operation （P〈0.05）, whereas in group A and C had no significant difference. There was no significant difference at 48 h in all of the groups. The score of sedation in group B, C was sig- nificantly lower than that in group A at the 1st day （P〈0.05）, and there was no significant differ- ence in each group at 2rd day after operation （P〉0.05）. Conclusion For patients undergoing total hysterectomy, preoperative oral gabapentin 300 mg combined with postoperative epldural morphine is a better method for postoperative analgesia and can reduce the consumption and side effect of mor- phine.