多瑞吉用于术后镇痛的临床研究

目的　探讨多瑞吉用于术后镇痛的效能和安全性。方法　择期上腹部手术病人 2 7例 ,随机分为两组 ,多瑞吉组 (D组 ) 13例 ,对照组 (C组 ) 14例。术前 45分钟 ,D组两侧锁骨下各贴 1片 2 5 μg/h的贴膜 ,C组予不含药物的贴片。贴膜应用 2 4小时后 ,两组病人均去除贴膜。术中两组均采用气管插管静吸复合麻醉 ,手术结束病人立即送PACU ,拔管、病人清醒诉痛后 ,应用吗啡PCA泵 ,所有病人持续监测SpO2 、RR、ECG、NBP 44小时 ,每隔 4小时记录一次吗啡用量、VAS评分 ,并观察有无恶心、呕吐、瘙痒、尿潴留等副反应。结果　 (1)镇痛效果 :术后各时段D组VAS评分均明显优于C组 ;(2 )吗啡用量 :术后 4小时、8小时D组吗啡用量与C组无统计学差异 ,8小时后D组吗啡用量明显少于C组 ;(3)呼吸影响 :两组病例均未出现SpO2 低于 90 % ,D组呼吸频率术后与术前无明显差异 ;(4)副反应 :恶心、呕吐、瘙痒、尿潴留发生率两组相似。结论　 5 0 μg/h多瑞吉用于成人 1小时左右上腹部手术是安全有效的 ,并且不明显增加副反应发生     

维拉帕米在硬膜外术后镇痛中对吗啡的增效作用

目的　比较硬膜外单独注射吗啡与吗啡加维拉帕米在术后镇痛方面的疗效。方法　2 70例在硬膜外麻醉下行腹部手术的患者 ,随机分为三组 ,吗啡加维拉帕米组 (MV组 )、吗啡 1mg组(M 1组 )、吗啡 2mg组 (M2组 ) ,每组 90例。MV组 :吗啡 1mg +维拉帕米 0 2 5mg +0 9%NaCl稀释到 10ml;M 1组 :吗啡 1mg +0 9%NaCl稀释到 10ml;M2组 :吗啡 2mg +0 9%NaCl稀释到10ml。均于手术结束时由硬膜外导管缓慢注入硬膜外腔。观察 15min后拔除硬膜外导管送回病房。手术后 12、2 4、4 8h记录疼痛评分 (VAS)、平均动脉压和呼吸频率、脉搏血氧饱和度 ,以及尿潴留、恶心、呕吐等不良反应情况。结果　术后 4 8h内MV组镇痛效果明显优于M 1组 (P <0 0 5 ) ,与M2组相近 (P >0 0 5 ) ,但不良反应发生率MV组明显低于M2组 (P <0 0 1)。三组的呼吸循环及脉搏血氧饱和度无显著差异。结论　维拉帕米在硬膜外术后镇痛中对吗啡有增效作用 ,可减少吗啡的用量 ,从而减少吗啡的不良反应 ,并取得良好的术后镇痛效果     

氟哌利多减轻吗啡所致恶心呕吐的临床观察

60例全麻开胸手术病人随机分为3组,每组20例。A组(对照组):吗啡用量0.025 mg/kg/h;B组:吗啡用量同A组,加氟哌利多5 mg;C组:吗啡用量同A组,加氟哌利多10mg。采用美国百特“便携式Infusor输注泵”2C1008K型,均匀流量2mg/h,配制术后48小时的镇痛药液96 ml,记录术后4、8、12、24、48小时镇痛、镇静、恶心呕吐的情况。结果显示三组均有较理想的镇痛效果,镇静作用B组、C组明显高于A组(P<0.05);恶心呕吐的发生率B组、C组明显低于A组(P<0.01)。所以本文结果提示氟哌利多加入吗啡药液中能明显减少病人恶心呕吐的发生。     

硬膜外负荷量吗啡加芬太尼应用于剖宫产术后镇痛的观察

目的观察预充负荷量吗啡和芬太尼复合液对吗啡术后镇痛的影响。方法选择剖宫产手术80例,年龄23～34岁,ASAⅠ～Ⅱ级,无心、肺、肾及神经系统疾病,无长期服用镇痛药和镇静药病史,均采用硬腰联合麻醉,根据负荷量的不同随机分为吗啡组(M组)和吗啡+芬太尼组(F+M组),负荷量配方:M组吗啡2mg+昂丹司琼4mg稀释到5mL,F+M组吗啡1mg+芬太尼0.1mg+昂丹司琼4mg稀释到5mL。采用视觉模式评分法评估产妇镇痛效果,观察2组患者不良反应。结果 M组与F+M组VAS评分在1h和2h差异有统计学意义(P(0.01,P(0.05),4h、8h、12h2组患者VAS评分差异无统计学意义(P(0.05)。2组患者均无呼吸抑制,恶心、呕吐和瘙痒发生率差异均无统计学意义(P(0.05)。结论在负荷量中吗啡和芬太尼联合使用既能够明显增强术后早期镇痛作用,又不会明显增加稍后镇痛泵中吗啡持续应用所产生的不良反应,值得推广应用。     

芬太尼、吗啡PCSA用于心外术后镇痛疗效的随机对照研究

目的　对皮下芬太尼或吗啡病人自控镇痛 (PCA)的疗效及安全性进行评价。方法　将 6 0例ASAⅠ～Ⅲ级心外术后病人随机分成芬太尼与吗啡病人皮下自控镇痛 (PCSA)组 ,其中芬太尼组 2 9例 ,吗啡组 31例。药物配方 :芬太尼组为 1ml药液中含芬太尼 2 5 μg、利多卡因 10mg ;吗啡组为 1ml药液中含吗啡 1mg、利多卡因 10mg ;PCA设置 :负荷量 2ml,单次剂量 1ml,小时限量 10ml,锁定时间 3分钟。于负荷量注射完毕后记录镇痛起效时间 ,并于放置PCSA泵后 2 4、48、和 72小时记录以下指标 :安静、咳嗽和运动时疼痛VAS评分 ,镇静程度 ,PCA需求按压和有效按压次数 ,MAP、HR、RR、SpO2 及副作用。结果　镇痛效果 :芬太尼组镇痛起效时间显著短于吗啡组 (P <0 0 5 ) ;芬太尼组PCA药物用量、需求按压和有效按压次数显著高于吗啡组 (P <0 0 5 ) ;吗啡组恶心、呕吐的发生率明显高于芬太尼组 (P <0 0 5 )。结论　芬太尼、吗啡PCSA操作简单、系统故障发生率低 ,适于较长时间留置     

不同浓度氯普鲁卡因复合吗啡应用于直肠癌术后硬膜外镇痛效果的临床观察

为观察氯普鲁卡因复合吗啡应用于直肠癌术后硬膜外镇痛的临床效果,我们选择120例直肠癌患者,其中行直肠癌根治术（经腹会阴联合直肠癌切除术）52例,直肠癌切除术68例,随机分成A、B、C三组,各40例。A组中,直肠癌根治术16例,直肠癌切除术24例;B组中,直肠癌根治术17例,直肠癌切除术23例;C组中,直肠癌根治术19例,直肠癌切除术21例。术后给予硬膜外持续镇痛。A组用1．0％氯普鲁卡因＋0．1mg／ml吗啡,B组用1．2％氯普鲁卡因＋0．1mg／ml吗啡,C组用1．5％氯普鲁卡因＋0．1mg／ml吗啡。结果显示,A组镇痛效果较差,VAS为28．0±4．7～57．0±6．2,有13例诉求3％氯普鲁卡因5ml或哌替啶100mg肌肉注射;B组镇痛效果较好,VAS为9．5±2．3～13．0±4．4;C组镇痛效果好,VAS为8．7±3．3～11．0±3．5。B,C组均无额外诉求,但B组与C组VAs评分差异无统计学意义,P〉0．05。结果表明,氯普鲁卡因复合吗啡应用于直肠癌术后硬膜外镇痛效果良好,其中以1．2％和1．5％浓度为好。     

昂丹司琼预防剖宫产术后曲马多持续镇痛所致的恶心呕吐

目的 探讨昂丹司琼不同给药方式对剖宫产术后曲马多持续镇痛所致术后恶心呕吐(PONV)的防治效果.方法 80例腰-硬联合麻醉下行剖宫产手术的产妇随机均分为四组:A组昂丹司琼8 mg加入曲马多镇痛泵持续输注;B组昂丹司琼8 mg在胎儿娩出后缓慢静注;C组昂丹司琼4 mg胎儿娩出后单次静注并4 mg镇痛泵持续输注;D组胎儿娩出后静注生理盐水4 ml,所有患者均行术后曲马多静脉自控镇痛(PCIA).观察并记录四组术后1、6、8、12、24 h时PONV评分及疼痛VAS评分.结果 四组间不同时点疼痛VAS评分差异无统计学意义.术后1、6、8、12、24 PONV评分A、B、C组明显低于D组(P＜0.01),C组明显低于A、B组(P＜0.05);A、B组间差异无统计学意义,与术后6h比较,术后1hA组及术后12、24hA、B后PONV评分明显降低(P＜0.05).结论 昂丹司琼可有效预防曲马多术后镇痛引起的恶心呕吐,但在胎儿娩出后单次静注昂丹司琼4mg,并4mg于PCA中持续输注,其预防效果更佳.     

帕瑞昔布对剖宫产术后病人不同剂量吗啡硬膜外镇痛效果的影响

目的 评价帕瑞昔布对剖宫产术后病人不同剂量吗啡硬膜外镇痛效果的影响.方法 择期行剖宫产手术的病人300例,ASA分级Ⅰ或Ⅱ级,年龄20～40岁,体重54 ～ 89 kg,采用随机数字表法,将其随机分为6组(n＝50):帕瑞昔布联合常规剂量吗啡PCEA组(P1组)、帕瑞昔布联合中剂量吗啡PCEA组(P2组)、帕瑞昔布联合小剂量吗啡PCEA组(P3组),3组各设置生理盐水联合吗啡PCEA对照组(C1组、C2组和C3组).于手术结束时P1组、P2组和P3组静脉注射帕瑞昔布40 ng,C1组、C2组和C3组给予等容量生理盐水.6组术后行吗啡PCEA,C1组和P1组:负荷量为吗啡2.0mg,镇痛泵药物为吗啡3.0 mg;C2组和P2组:负荷量为吗啡1.5mg,镇痛泵药物为吗啡2.0 mg;C3组和P3组:负荷量为吗啡1.0 mg,镇痛泵药物为吗啡1.5 mg;负荷量中均加入0.15％罗哌卡因8ml,所有镇痛泵中药物均加入罗哌卡因150 mg、格拉司琼3 mg和地塞米松5 mg,用生理盐水稀释至100 ml,背景输注速率2 ml/h,PCA量0.5ml,锁定时间15 min.分别记录术毕～术后24h期间静息状态及活动状态时镇痛有效情况,记录恶心呕吐、皮肤瘙痒、呼吸抑制、低血压和嗜睡等不良反应的发生情况.结果 与C1组或G2组比较,P1组或P2组术后活动状态和静息状态镇痛有效率差异无统计学意义(P＞0.05);与C3组比较,P3组活动状态镇痛有效率升高(P<0.01),静息状态镇痛有效率差异无统计学意义(P＞0.05).与P1组和P2组比较,P3组恶心呕吐程度和皮肤瘙痒发生率降低(P<0.01),无一例病人发生呼吸抑制、低血压和嗜睡.结论 静脉注射帕瑞昔布40 mg可增强剖宫产术后小剂量吗啡硬膜外镇痛的效果,而对中等剂量或常规剂量吗啡硬膜外镇痛效果无影响.     

不同方式氟比洛芬酯复合芬太尼术后镇痛效果的比较:前瞻性、多中心、随机、双盲、对照、平行分组研究

目的 比较不同方式氟比洛芬酯复合芬太尼用于术后镇痛的效果.方法 本研究为前瞻性、多中心、随机、双盲、对照、平行分组研究.选择2010年1月至2010年10月择期行骨科、胸外科、肝胆外科等大中型手术的病人,ASA分级Ⅰ或Ⅱ级,年龄14 ～ 91岁,体重35 ～ 95 kg,采用随机数字表法,将其分为3组,A组:术毕即刻静脉注射氟比洛芬酯100 mg,然后芬太尼1.0 mg用生理盐水稀释至100 ml,进行PCIA;B组:氟比洛芬酯200 mg+芬太尼0.6 mg用生理盐水配稀释至100 ml,进行PCIA;C组:术毕即刻静脉注射氟比洛芬酯100 mg,氟比洛芬酯200 mg+芬太尼0.6 mg用生理盐水稀释至100 ml进行PCIA.3组背景输注速率2 ml/h,PCA量2 ml,锁定时间10 min.分别于术毕、术后4、8和24 h时记录静态和动态VAS评分和镇静评分.术后24 h内记录镇痛有效、过度镇静、恶心、呕吐、瘙痒、头晕、嗜睡和呼吸抑制的发生情况.术后24和48 h时随机选择一个中心B组镇痛泵内容物,取样后进行微生物培养试验.结果 共完成2596例,其中A组875例、B组946例、C组775例.与A组比较,B组术毕、术后4、8和24h时静态和动态VAS评分和各时点镇静评分均降低,C组术毕、术后4、8h时静态和动态VAS评分均降低,术后4、8h时镇静评分升高,2组镇痛有效率均升高,B组过度镇静发生率降低,C组过度镇静发生率升高,2组术后恶心和呕吐的发生率降低,C组术后头晕发生率降低(P＜0.05);与B组比较,C组各时点静态和动态VAS评分、镇痛有效率、恶心、呕吐以及瘙痒发生率差异无统计学意义(P＞0.05),术毕、术后4、8h时镇静评分升高,过度镇静发生率升高,头晕发生率降低(P＜0.05).术后24、48 h时泵内容物标本细菌和真菌培养均为阴性.结论 对于大中型手术病人,氟比洛芬200 mg复合芬太尼0.6 mg PCIA(背景输注速率2 ml/h,PCA量2 ml,锁定时间10 min)术后镇痛的效果更佳,且不良反应发生几率低.     

不同剂量的吗啡镇痛对剖宫产患者应激的影响

目的:比较不同剂量的吗啡镇痛对剖宫产患者应激以及不良反应产生的影响,以确定比较理想的镇痛剂量。方法:将60例足月剖宫产妇随机分为A、B、C组,每组20例,各组平均年龄和体重比较,无统计学差异(P>0.05),三组使用吗啡剂量分别为0.2mg(A组)、0.3mg(B组)、0.4mg(C组)。L2-3或L3-4穿刺,向蛛网膜下腔内注入10%葡萄糖1ml+0.75%布比卡因1ml+相应剂量吗啡,所有患者术均皮下或静脉注入氟哌利多2.5mg。结果:与T0时比较,T24、T48时三组血浆Cor和Gl u水平均显著升高(P<0.05),但B组和C组升高幅度显著低于A组(P<0.05)。与A组比较,T4～T48时B组和C组的VAS均低于A组(P<0.05)。C组的瘙痒程度明显高于A组和B组。结论:0.3mg吗啡镇痛能减轻因手术带来的应激反应,而且镇痛完善,不良反应少。因此,腰麻药中加入0.3mg吗啡镇痛在剖宫产术中效果最好,值得广泛的推广。     

吗啡硬膜外镇痛剂量与患者术后尿潴留的关系

目的 评价吗啡硬膜外镇痛剂量与患者术后尿潴留的关系.方法 择期行膝关节镜手术的患者60例,年龄20～56岁,体重49～76 kg,性别不限,ASA Ⅰ级,随机分为3组(n=20),对照组(C组)硬膜外腔注射生理盐水5 ml;M1,2组硬膜外腔分别注射吗啡1和3 mg.采用Micro Maxx便携式超声仪测量患者膀胱尿量,记录术后产生排尿冲动时的膀胱尿量和首次排尿时间;于麻醉前和术后记录视觉模拟评分(VAS评分);记录术后尿潴留(膀胱尿量≥600 ml且30min内不能自行排尿)、恶心呕吐及瘙痒的发生情况.结果 与C组比较,M2组尿潴留发生率升高,VAS评分降低,M1,2组首次排尿时间延长,产生排尿冲动时的膀胱尿量增多,瘙痒发生率升高(P<0.05或0.01);与M1组比较,M2组尿潴留发生率升高、首次排尿时间延长,产生排尿冲动时的膀胱尿量增多,术后瘙痒发生率升高(P<0.05),VAS评分和镇痛有效率差异无统计学意义(P>0.05).结论 吗啡硬膜外剂量与患者术后尿潴留的发生有关,呈剂量依赖性,1 mg为推荐剂量.     

Does epidural fentanyl decrease the efficacy of epidural morphine after cesarean delivery?

Earlier studies have suggested that epidural fentanyl improves intraoperative analgesia during cesarean section, but others have suggested that it worsens postoperative analgesia from epidural morphine. The purpose of this study was to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Sixty patients having epidural anesthesia for cesarean delivery were studied. Epidural anesthesia was established using 2% lidocaine with epinephrine 5 micrograms/mL. After delivery, either fentanyl 100 micrograms/10 mL or normal saline-control 10 mL was injected through the epidural catheter in a randomized, double-blind manner. All patients received 3.5 mg of morphine epidurally after uterine repair. After administration of the epidural study drug, there were no significant differences in the pain responses during surgery between the two groups. Patients in the fentanyl group experienced significantly less nausea and vomiting between delivery and the end of surgery than did patients in the normal saline-control group (P = 0.013). Postoperatively, visual analogue scale scores for pain, pruritus, nausea, and sedation were similar at 1, 2, 4, and 8 h in the two groups. We conclude that fentanyl 100 micrograms administered epidurally during cesarean delivery did not improve intraoperative analgesia, but significantly reduced intraoperative nausea and vomiting without diminishing the efficacy of postoperative analgesia provided by epidural morphine.     

Continuous epidural, not intravenous, droperidol inhibits pruritus, nausea, and vomiting during epidural morphine analgesia

PURPOSE: To investigate whether continuous epidural droperidol and intravenous (IV) intraoperative droperidol inhibit pruritus and postoperative nausea and vomiting (PONV) during epidural morphine analgesia. DESIGN: Randomized, double-blinded, controlled study. SETTING: Metropolitan cancer center. PATIENTS: 120 ASA physical status I and II patients undergoing thoracic or abdominal surgery with general anesthesia combined with epidural anesthesia. INTERVENTIONS: Patients received an intraoperative epidural injection of 2 mg morphine hydrochloride, followed postoperatively by a continuous epidural infusion of morphine hydrochloride 4 mg/day for 4 days. Patients were randomly allocated to four groups: Group A = control group, Group B = intraoperative single IV injection of droperidol (2.5 mg), Group C = postoperative continuous epidural droperidol infusion (2.5 mg/day), and Group D = intraoperative IV injection of droperidol (2.5 mg) and postoperative continuous epidural droperidol infusion (2.5 mg/day). MEASUREMENTS AND MAIN RESULTS: The frequency and severity of pruritus and PONV in each group were evaluated during the postoperative period. Continuous epidural infusion of droperidol significantly reduced the frequency and severity of pruritus and PONV induced by epidural morphine without causing significant side effects. Intraoperative single IV injection of droperidol was effective for PONV (p < 0.05) but not for pruritus. CONCLUSION: Postoperative epidural droperidol infusion significantly decreased both the frequency and severity of pruritus and PONV during postoperative continuous epidural morphine analgesia. IV intraoperative droperidol significantly reduced the frequency and the severity of PONV but not pruritus.     

布托啡诺与吗啡用于腹部手术后硬膜外镇痛效果的比较

目的 研究不同剂量布托啡诺用于腹部手术患者术后硬膜外镇痛的效果及副作用,并与吗啡硬膜外镇痛进行比较. 方法 择期腹部手术ASAⅠ～Ⅱ级患者75例,按术后镇痛用药不同随机分为3组(n=25):M组(吗啡12 mg+0.1%罗哌卡因共150ml),B1组(布托啡诺9mg+0.1%罗哌卡因共150 ml),B2组(布托啡诺12mg+0-1%罗哌卡因共150ml).负荷量为0.25%罗哌卡因5 ml加吗啡2 mg或布托啡诺2 mg,持续背景输注剂量均为1-5 ml/h,按压追加药量均为2 ml/次,按压锁定时间20 min.观察记录3组患者术中芬太尼的总药量;术后1、4、8、12、18、24、36、48 h各时间点的疼痛视觉模拟评分(pain visual analogue scores,VAS);术后1、4、8、12 h的警觉镇静评分(observer's assessment ofalertness/sedation scores,OAA/S);术后48 h内按压总次数及总药量;肛门排气时间;术后镇痛副作用(头痛头晕、嗜睡、呼吸抑制、搔痒、恶心、呕吐、腹胀)的发生情况.结果 术后4 h时间点B1组VAS评分为2.8±1.0,高于M组的2.0±0.7及B2组的2.0±0.9(P<0-05),其余时间点3组间比较差异无统计学意义(P>0.05).M组的头痛头晕、恶心、呕吐,腹胀,搔痒发生例数分别为3、11、7、4、5例,而B1组仅有1例头痛头晕,B2组有2例头痛头晕,1例恶心,发生率均低于M组(P<0.05).3组患者术中芬太尼的总药量、48 h内按压总次数及总药量、术后不同时间点OAA/S评分及肛门排气时间的比较差异无统计学意义(P>0.05). 结论 每天3 mg～4 mg布托啡诺应用于腹部手术后硬膜外镇痛,镇痛效果确切,且其副作用发生率较吗啡明显降低.     

盐酸戊乙奎醚联合氟哌利多降低吗啡硬膜外术后镇痛的不良反应

目的观察盐酸戊乙奎醚联合氟哌利多对吗啡用于硬膜外术后镇痛不良反应发病率的影响。方法连续硬膜外麻醉行子宫下段剖宫产手术的患者96例,ASAⅠ或Ⅱ级,随机分为单纯吗啡组(A组)、吗啡 氟哌利多组(B组)、吗啡 盐酸戊乙奎醚组(C组)及吗啡 盐酸戊乙奎醚 氟哌利多组(D组),每组24例。术毕5min分别将各组吗啡混合液各自注入硬膜外腔后拔出硬膜外导管回病房,记录术后镇痛效果及术后恶心呕吐(PONV)、皮肤瘙痒、尿潴留、口干等不良反应。结果D组的镇痛效果明显优于A、B、C组(P<0.01),且PONV、皮肤瘙痒等不良反应发病率明显低于A、B、C组(P<0.05)。结论盐酸戊乙奎醚联合氟哌利多可明显降低吗啡用于硬膜外术后镇痛不良反应的发病率。     

Epidural morphine provides postoperative pain relief in peripheral vascular and orthopedic surgical patients: a dose-response study

A randomized double-blind study compared the dose-response relationship of epidural morphine for postoperative pain relief in two groups of patients whose surgical procedures would result in either moderate (femoral-popliteal bypass) or severe (total knee replacement) postoperative pain. Preservative-free morphine sulphate in doses of 0, 2, 5, or 10 mg in a volume of 10 ml saline were administered via lumbar epidural catheters. The epidural morphine was administered 1 hr after the last dose of intraoperative local epidural anesthetic in an effort to achieve a pain-free postoperative course. A significant relationship existed between the dose of epidural morphine and both time to first required pain medication and 24-hr weighted pain score. Five mg epidural morphine provided significant improvement in postoperative analgesia compared with the control in both groups. Further enhancement of analgesia occurred with 10 mg; however, late respiratory depression, demonstrated by an increased resting PaCO2 10 hr after administration, was seen only with the 10-mg dose in both surgical groups. Minor complications such as nausea, vomiting, pruritus, and urinary retention were uncommon and did not appear to be related to dose. We found that 5 mg epidural morphine provided long-lasting postoperative analgesia without serious adverse effects after peripheral vascular and orthopedic surgery.     

Effects of epidural naloxone on pruritus induced by epidural morphine: a randomized controlled trial

BACKGROUND: Epidural morphine produces prolonged analgesia but has many side effects including pruritus. Naloxone is an antagonist that can reverse the side effects of morphine. METHOD: We studied the effects of continuously administered epidural naloxone mixed with morphine on side effects and analgesia in a randomized, double blind, two-armed study. Fifty-eight pregnant women undergoing cesarean section were enrolled. All patients received a 4-mg epidural bolus of morphine in the post-anesthetic care unit. After this, patients in group M (n=28) received continuous epidural morphine (6 mg over 48 h) in 0.1% bupivacaine; patients in group N (n=30) received an epidural infusion containing naloxone (1.2 mg over 48 h) and morphine (6 mg over 48 h) in 0.1% bupivacaine. The infusion rate was 2 mL/h. RESULTS: The incidence (82% versus 47%) and severity of pruritus were lower in group N than group M (P=0.001). There were no significant differences in pain score or in the incidence of nausea, vomiting or urinary disturbance between groups. CONCLUSION: Continuous epidural infusion of naloxone combined with morphine is effective in reducing the incidence and severity of pruritus induced by epidural morphine.     

Prophylactic oral naltrexone with intrathecal morphine for cesarean section: effects on adverse reactions and analgesia

The influence of two different doses of oral naltrexone on the adverse effects and the analgesia associated with intrathecal morphine was compared in a double-blind, placebo-controlled study. Thirty-five patients undergoing cesarean section were provided postoperative analgesia by 0.25 mg intrathecal morphine. Sixty minutes later they were given 6 mg naltrexone, 3 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale. Requirements for additional analgesics and side effects were recorded. Duration of analgesia was shorter in the 3- and 6-mg naltrexone groups than in the placebo group, 10.0 +/- 2.6, 12.4 +/- 2.6, and 19.2 +/- 4.5 h (mean +/- SEM), respectively, but values did not reach statistical significance. The incidence of pruritus and vomiting was significantly less in the 6-mg naltrexone group than in the other two groups (P less than 0.05). Somnolence was significantly less in the 3- and 6-mg naltrexone groups than in the placebo group (P less than 0.05). Naltrexone (6 mg) is an effective oral prophylactic against the pruritus and vomiting associated with intrathecal morphine for analgesia after cesarean section, but it is associated with shorter duration of analgesia.     

不同剂量比例的纳络酮与吗啡合用于手术后硬膜外镇痛的临床观察

目的探讨将吗啡与小剂量纳络酮按不同比例混合作患者硬膜外术后镇痛（CEA＋PCEA模式）效果。方法选择90例ASAⅠ～Ⅲ级行择期下腹部手术、术后硬膜外镇痛的患者,随机分为A、B、C三组,每组各30例（n=30）。三组的镇痛配方中布比卡因与吗啡用量相同,A、B两组中纳络酮／吗啡的比例分别为1／50与1／100．C组不加纳络酮;观察术后48h内各组患者的副作用、镇痛以及呼吸抑制等情况。结果（1）恶心呕吐：在术后3—36小时内,A组明显轻于C组（P〈0．05）。（2）瘙痒：在术后大部分时间内（6～36h）C组均重于A、B两组（P〈0．05）。（3）三组患者术后的疼痛程度大致相当（P〉0．05）,三组患者术后神志、下肢活动及呼吸情况均未见异常。结论剂量比例为1／50的纳洛酮与吗啡合用于患者硬膜外镇痛,有明显减少恶心呕吐、瘙痒等吗啡的副作用．同时不影响患者的镇痛效果以及神志、下肢活动与呼吸情况。