联合用药预防吗啡术后镇痛期恶心呕吐

目的观察昂丹司琼、地塞米松、氟哌利多联合应用预防术后吗啡镇痛引起恶心呕吐（PONV）的作用。方法连续硬膜外行妇科手术的患者120例,ASAI～Ⅱ级,随机分为A、B、C、D、E、F6组。A组静注地塞米松针5mg;B组地塞米松针＋镇痛泵中加氟哌利多针2．5mg：C组地塞米松针5mg＋镇痛泵中加氟哌利多针1．25mg;D组地塞米松针5mg＋镇痛泵中加昂丹司琼4mg;E组地塞米松针5mg＋镇痛泵中加昂丹司琼8mg＋氟哌利多针1．25rag;F组静注生理盐水5mg。结果A、B、C、D、F每组20例止吐难以得到预防和治疗的效果,E组3种药物联合应用能够阻断引起PONV的多个病因使PONV发生率明显降低．从而达到预期的治疗目的。结论盐酸昂丹司琼、地塞米松、氟哌利多这三种药物联合应用能够阻断引起PONV的多个病因,使PONV发生率明显降低,从而达到预期的治疗目的。     

联合用药对全麻术后自控镇痛患者恶心呕吐的随机对照研究

目的探讨联合用药对术后自控镇痛患者恶心呕吐的疗效。方法 176例手术后应用患者自控镇痛(patient controlled analgesia,PCA)随机分为4组:A组,分别在术中、PCA泵中给予昂丹司琼8mg;B组,在PCA泵中给予地塞米松5mg、氟哌利多2.5mg;C组,在术中给予昂丹司琼8mg、PCA泵中给予地塞米松5mg、氟哌利多2.5mg及昂丹司琼8mg;D组,分别在术中给予昂丹司琼8mg、在PCA泵中给予地塞米松5mg及氟哌利多2.5mg。术后48h回访患者术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生情况。结果 4组PONV发生率分别为A组29.5%(13/44)、B组34.1%(15/44)、C组7.0%(3/43),D组11.4%(5/44),联合用药组即C组和D组PONV发生率明显低于单一用药组A组和B组(P0.05);A、B2组PONV发生率差异无显著性(χ2=0.210,P=0.647),C组PONV发生率与D组间差异无显著性(χ2=0.114,P=0.736)。结论联合应用昂丹司琼、地塞米松及氟哌利多3种止吐药可以显著减少术后自控镇痛患者的恶心呕吐的发生率。     

不同镇痛方法用于妇科手术病人术后镇痛的疗效观察

目的比较硬膜外单次注射吗啡与病人自控硬膜外镇痛(PCEA)、自控静脉镇痛(PCIA)在术后镇痛中的临床效果。方法选择美国麻醉医学会(ASA)Ⅰ～Ⅱ级行妇科手术的病人60例。随机分为吗啡组(A组)、吗啡PCEA组(B组)和吗啡PCIA组(C组)。每组20例。A组在手术结束时硬膜外腔注射吗啡2 mg+盐酸罗哌卡因15 mg,B组在手术结束时硬膜外腔注射吗啡0.5 mg+盐酸罗哌卡因15 mg,并经硬膜外导管接自控止痛泵,C组在手术结束时硬膜外腔注射吗啡0.5 mg+盐酸罗哌卡因15 mg,并经静脉接自控止痛泵。记录A、B、C 3组术后4、8、12、24、48h各时间点VAS评分和恶心呕吐、皮肤瘙痒、呼吸抑制、下肢麻木等不良反应的发生情况。结果B、C组8、12、24、48h各时间点VAS评分均低于A组(P0.01)。B组下肢麻木的发生高于A组、C组(P0.05)。结论PCIA泵、PCEA泵均能产生良好的术后镇痛效果。PCIA泵具有避免PCEA泵一些严重并发症的发生。     

芬太尼、吗啡或丁丙诺啡复合罗哌卡因用于经尿道前列腺电切术后病人自控硬膜外镇痛

目的评价经尿道前列腺汽化电切术(TUVP)术后分别应用芬太尼、吗啡、丁丙诺啡复合罗哌卡因行硬膜外病人自控镇痛(PCEA)的效果。方法择期行TUVP的患者60例,随机均分为三组,分别在术后予硬膜外0.4mg芬太尼 0.125%罗哌卡因共100ml镇痛(A组)、4mg吗啡 0.125%罗哌卡因共100ml镇痛(B组)、0.45mg丁丙诺啡 0.125%罗哌卡因共100ml镇痛(C组),比较生命体征、视觉模拟评分(VAS)和不良反应。结果三组病人术后循环均稳定。三组术后VAS差异无统计学意义。A组不良反应少,但发生膀胱痉挛性疼痛及尿道紧迫感明显高于B组和C组(P<0.05);B组镇痛效果好,但恶心、呕吐、皮肤瘙痒等不良反应发生率高于A组和C组;C组镇痛效果好,不良反应发生率低。结论丁丙诺啡复合罗哌卡因对TUVP病人术后PCEA效果确切,循环呼吸稳定,不良反应少。     

罗哌卡因复合曲马多用于剖宫产术后镇痛的临床观察

目的 观察腰-硬联合麻醉(CSEA)在剖宫产术后应用不同浓度罗哌卡因复合曲马多行病人自控硬膜外镇痛(PCEA)的镇痛效果和不良反应.方法 60例足月初产妇,ASA Ⅰ或Ⅱ级,在CSEA下行择期剖宫产术.术后采用不同浓度罗哌卡因复合曲马多行PCEA.随机均分为0.125%罗哌卡因 0.5%曲马多 0.0025%氟哌利多组(A组)、0.15%罗哌卡因 0.5%曲马多 0.0025%氟哌利多组(B组)和0.2%罗哌卡因 0.5%曲马多 0.0025%氟哌利多组(C组).于镇痛后12、24和48 h观察并记录静态和动态VAS、下肢运动阻滞程度、循环状况和不良反应.结果 C组12、24、48 h动态VAS值明显低于A和B组(P<0.05);B组12、24、48 h动态VAS值又低于A组(P<0.05).C组镇痛开始后双下肢肌力明显低于A和B组(P<0.05).三组产妇镇痛后6、12、24、48 h的收缩压、舒张压、心率差异均无统计学意义.三组产妇镇痛期间均未发生瘙痒;24 h时拔除尿管均自行排尿和下床行走.三组恶心、呕吐发生率差异无统计学意义;胃肠功能恢复情况差异也无统计学意义.结论 剖宫产术后采用0.125%、0.15%或0.2%罗哌卡因 0.5%曲马多 0.0025%氟哌利多行PCEA术后镇痛,均能产生不同程度的切口镇痛效果,未见严重不良反应.但以选用0.15%罗哌卡因 0.5%曲马多 0.0025%氟哌利多的配方较为优良.     

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。     

氟哌啶预防PCEA中恶心、呕吐、皮肤瘙痒的临床观察

吗啡类药物术后硬膜外腔持续镇痛(PCEA)效果肯定，但恶心、呕吐，皮肤瘙痒，尿潴留等并发症也颇为常见。我院从2001年8月1日至2002年2月28日期间对472例术后PCEA病人，随机分为A、B两组，分别采用两种镇痛药液配方，观察氟哌利多在预防恶心、呕吐、皮肤瘙痒等吗啡副作用的效果。     

硬膜外吗啡和氟哌利多超前镇痛的临床研究

目的：比较硬膜外吗啡和氟哌利多超前镇痛与术后镇痛的临床效果和安全性。方法：选择ASAⅠ～Ⅱ级，年龄37～49岁，择期在硬膜外麻醉下行妇科手术的患者30例，随机分为超前镇痛组(Ⅰ组)和术后镇痛组(Ⅱ组)，每组15例。Ⅰ组在术前20min经硬膜外导管一次性注入吗啡2．0mg和氟哌利多1．25mg；Ⅱ组在术毕即硬膜外注入上述等量药物。术后2、4、8、12、24h随访并记录镇痛效果、镇静程度及不良反应，监测血压、心率、呼吸频率、脉搏血氧饱和度；术中记录局麻药用量。结果：超前镇痛组术后8～24h镇痛效果优于术后镇痛组，且局麻药用量减少。结论：硬膜外吗啡和氟哌利多超前镇痛效果优于术后镇痛。     

芬太尼、吗啡、丁丙诺啡复合局麻药分别行硬膜外术后镇痛效果观察对比

目的 :探讨术后分别应用芬太尼、吗啡、丁丙诺啡复合局麻药及氟哌利多行硬膜外自控镇痛 ,观察其镇痛效果及不良反应发生率 ,综合比较哪种药物配方更理想。方法 :选择ASAⅠ～Ⅱ级 ,年龄 2 2～ 30岁 ,体重无较大差异的妇产科手术病人 6 0例 ,随机分为A、B、C三组 (每组 2 0例 ) ,均行硬膜外麻醉。术后接止痛泵行PCEA。单次剂量 1ml,锁定时间 2 0min ,术后随访 2d。结果 :从镇痛效果比较 ,A组为 50 % ,B组 75% ,C组为 80 %。结论 :芬太尼配方组不良反应少 ,但镇痛效果差 ;吗啡配方组镇痛好 ,但不良反应发生率高 ;丁丙诺啡组镇痛效果最好 ,不良反应发生率低 ,故选用丁丙诺啡 0 .6mg ,氟哌利多 2 .5mg ,复合 0 .1 1 2 5%布比卡因 1 0 0ml行妇产科手术后PCEA是一种较理想的药物配方。     

不同剂量盐酸戊乙奎醚对老年病人术后认知功能的影响

目的 探讨不同剂量盐酸戊乙奎醚对老年病人术后认知功能的影响.方法 拟在全麻下行腹部手术的老年病人93例,年龄≥65岁,体重55～ 71 kg,性别不限,ASA分级Ⅰ级或Ⅱ级,简易智力量表评分(MMSE评分)＞27分,采用随机数字表法,将病人随机分为3组(n=31)∶盐酸戊乙奎醚0.010 mg/kg组(A组)、盐酸戊乙奎醚0.015 mg/kg组(B组)和阿托品0.010 mg/kg组(C组).麻醉前30min,A组肌肉注射盐酸戊乙奎醚0.010 mg/kg,B组肌肉注射盐酸戊乙奎醚0.015 mg/kg,C组肌肉注射阿托品0.010 mg/kg.于术后72 h内行MMSE评分,≤27分为发生认知功能障碍(24～ 27分为轻度;19 ～ 23分为中度;0～18分为重度).记录术后72 h内术后认知功能障碍的发生情况和程度.结果 与A组比较,B组术后各时点认知功能降低,术后认知功能障碍发生率升高(P＜0.05),A组和C组差异无统计学意义(P＞0.05);与B组比较,C组术后各时点认知功能增强,术后认知功能障碍发生率降低(P＜0.05).结论 盐酸戊乙奎醚可抑制老年病人术后认知功能,且与剂量有关.     

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.     

Intra-operative epidural morphine,fentanyl, and droperidol for control of pain after spinal surgery A prospective,randomized, placebo-controlled,and double-blind trial

Summary The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease.Three treatment groups were constituted: one with 5,0 mg morphine and 2,5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5,0 mg morphine and 0,1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation.In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group.In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.     

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

目的 比较术后单次硬膜外注射吗啡-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ASA Ⅰ～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L2-3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0.5 mg(4 ml),鼻喷与B组等剂...     

Preoperative epidural ketamine in combination with morphine does not have a clinically relevant intra- and postoperative opioid-sparing effect

In this prospective, randomized, and double-blinded clinical trial, we evaluated the efficacy of preincisional administration of epidural ketamine with morphine compared with epidural morphine alone for postoperative pain relief after major upper-abdominal surgery. We studied 50 ASA I and II patients undergoing major upper-abdominal procedures. These patients were randomly allocated to one of the two treatment groups: patients in Group 1 received epidural morphine 50 microg/kg, whereas those in Group 2 received epidural ketamine 1 mg/kg combined with 50 microg/kg of morphine 30 min before incision. Intraoperative analgesia was provided in addition, with IV morphine, and the requirement was noted. A blinded observer using a visual analog scale for pain assessment observed patients for 48 h after surgery. Additional doses of epidural morphine were provided when the visual analog scale score was more than 4. Analgesic requirements and side effects were compared between the two groups. There were no differences between the two groups with respect to age, sex, weight, or duration or type of the surgical procedures. The intraoperative morphine requirement was significantly (P = 0.018) less in Group 2 patients (median, 6.8 mg; range, 3-15 mg) compared with patients in Group 1 (median, 8.3 mg; range, 4.5-15 mg). The time for the first requirement of analgesia was significantly (P = 0.021) longer (median, 17 h; range, 10-48 h) in Group 2 patients than in Group 1 (median, 12 h; range, 4-36 h). The total number of supplemental doses of epidural morphine required in the first 48 h after surgery was comparable (P = 0.1977) in both groups. Sedation scores were similar in both groups. One patient in Group 2 developed hallucinations after study drug administration. None of the patients in either group developed respiratory depression. Other side effects, such as pruritus, nausea, and vomiting, were also similar in both groups. Although the addition of ketamine had synergistic analgesic effects with morphine (reduced intraoperative morphine consumption and prolonged time for first requirement of analgesia), there was no long- lasting preemptive benefit seen with this combination (in terms of reduction in supplemental analgesia) for patients undergoing major upper-abdominal procedures. IMPLICATIONS: Ketamine added to epidural morphine given before surgery can decrease postoperative pain by its preemptive effect, opioid potentiation, and prevention of acute opioid tolerance. A single epidural bolus of 1 mg/kg of ketamine with morphine given before major upper-abdominal surgery did not result in a clinically relevant reduction in postoperative pain relief.     

Postoperative epidural morphine for postpartum tubal ligation analgesia

Women undergoing postoperative postpartum tubal ligation (PPTL) often experience considerable pain. We hypothesized that epidural morphine, as part of a multi-modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to receive epidural saline or morphine 2 mg, 3 mg, or 4 mg after epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could request acetaminophen 325 mg/hydrocodone 10 mg. The primary outcome variable was time to first request for supplemental analgesia. Verbal rating scores for pain and the incidence and severity of side effects were recorded for 24 h. Morphine group subjects requested supplemental analgesia later and received fewer doses compared with the saline group subjects. Peak cramping and incisional verbal rating scores for pain and the area under the verbal rating scores for pain x time curve for cramping pain were less after epidural morphine compared with saline, but there were no differences among morphine groups. Nausea, vomiting, and pruritus occurred more often in all morphine groups and subjects who received morphine 4 mg required treatment for these side effects more frequently than the saline or morphine 2 mg groups. In conclusion, epidural morphine 2 mg as part of a multi-modal analgesic regimen improved analgesia and decreased the need for supplemental analgesics after PPTL. The need to treat side effects with morphine 2 mg was not increased compared to a regimen of oral acetaminophen/opioid/nonsteroidal antiinflammatory analgesics.     

Epidural dexamethasone reduces postoperative pain and analgesic requirements

PURPOSE: Epidural steroids may have potential advantages for providing postoperative analgesia. We therefore undertook a study to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following laparoscopic cholecystectomy. METHODS: In a randomized, double-blind study, 94 patients undergoing laparoscopic cholecystectomy were randomly assigned to one of three groups. Group 1 (Control) patients received dexamethasone 5 mg iv with epidural injection of 0.25% bupivacaine 8 mL and normal saline 2 mL, Group 2 (D1) patients received normal saline 2 mL iv with epidural injection of 0.25% bupivacaine 8 mL and dexamethasone 5 mg in normal saline 2 mL, and Group 3 (D2) patients received normal saline 2 mL iv with epidural injection of dexamethasone 5 mg in normal saline 10 mL. After surgery, morphine 2-4 mg iv was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale (VAS) pain scores at rest and with effort, and time to first analgesic administration were recorded by a blinded observer. RESULTS: Total morphine consumption for the first 24 hr following surgery was lower in both epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reduction in morphine consumption in Group D1 was 53.9% and in Group D2 was 52.9% in the first 24 hr. Postoperatively at 12 hr, 18 hr and 24 hr, the VAS scores at rest and during effort were also lower in the epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reductions in VAS scores with effort at 12 hr, 18 hr and 24 hr in Group D1 were 50%, 52.9% and 50% respectively, and in Group D2 percentage reductions in pain scores with effort were 54.8%, 58.8% and 55.5% at corresponding sampling intervals. CONCLUSION: Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following laparoscopic cholecystectomy.     

Comparison of epidurally administered sufentanil, morphine, and sufentanil-morphine combination for postoperative analgesia

Postoperative analgesia provided by epidurally administered sufentanil and/or morphine was evaluated in 45 patients recovering from major gynecologic surgery. At the first complaint of pain in the Postanesthesia Care Unit, patients received a single epidural bolus of 30 micrograms sufentanil (group A), 5 mg morphine (group B), or 30 micrograms sufentanil plus 3 mg morphine (group C) in a randomized blinded fashion. Analgesic efficacy was assessed throughout the 24-h study period with 10-cm visual analog scales. The need for additional postoperative analgesia (patient-controlled analgesia, 1 mg of morphine every 6 min as necessary) and the incidence of adverse effects were also assessed. Patients receiving sufentanil (groups A and C) had significantly faster onset of analgesia than did patients given morphine alone (group B, P less than 0.05). Group B subjects experienced the longest duration of analgesia (B vs A and C, P less than 0.05) and required significantly less patient-controlled analgesia (morphine) than patients in group A (P less than 0.05). No patient developed clinically significant respiratory depression or excessive sedation, and there were no intergroup differences in incidence of pruritus or nausea (P value not significant). The data indicate that a mixture of sufentanil and morphine provides either a more rapid onset of epidural analgesia or reduced patient-controlled analgesia narcotic requirement than respective doses of each agent administered alone.     

罗哌卡因硬膜外持续输注下氯诺昔康PCIA的临床效应

目的 研究硬膜外持续输注罗哌卡因期间氯诺昔康静脉PCA的临床效应和不良反应,并以吗啡对照比较。方法 选择60例(ASAⅠ～Ⅱ)妇科经腹子宫全切手术病人,随机分为L组与M组,双盲观察,均采用双泵行PCA治疗。其PCA设置为Bolus 1ml/次,锁定时间为5min,1h限量12ml。镇痛效果和副作用评定:(1)采用视觉模拟评分(VAS),0为无痛、10为剧痛。(2)BCS舒适评分。(3)病人对PCA总体印象评分。(4)记录可能出现的并发症和不良反应。结果 两组病人的一般情况相似,24h硬膜外罗哌卡因使用剂量均为192mg,L组与M组未按压PCA泵的病人各为5例(21.7％),静脉PCA用药剂量分别为(3.4±2.8)mg(L组)和(4.7±3.5)mg(M组),两药用量比值为1:1.4(P>0.05);相同时间段内两组间VAS、BCS、Bromage评分及D1/D2比值均无统计学差异。结论0.2％罗哌卡因硬膜外持续输注(4ml/h)能明显减少静脉PCA用量,新型非甾体类抗炎药氯诺昔康与吗啡静脉用药效价相似,但氯诺昔康对病人恶心呕吐的不良反应具有明显减少的优点。     

Epidural administration of low-dose morphine combined with clonidine for postoperative analgesia after lumbar disc surgery.

This study evaluates the efficacy and side effects of a low dose of epidural morphine combined with clonidine for postoperative pain relief after lumbar disc surgery. In 36 of 51 patients who accepted the procedure, an epidural catheter was inserted (L1-L2 level). General anesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in O2/N2O. After emergence from anesthesia, epidural analgesia was initiated according to two randomly assigned protocols: 1 mg of morphine with 75 microg of clonidine (Group M) or 12.5 mg of bupivacaine with 75 microg of clonidine (Group B), in 10 mL saline. Piritramide was administered during the first postoperative 24 hours using a patient-controlled analgesia device (PCA). The following parameters were recorded: piritramide consumption during the first 24 hours; pain at rest during the first postoperative hours (D0), during the first night (D1), and during the first mobilization; [visual analogue scale (VAS)]; and the occurrence of drowsiness, motor blockade, respiratory depression, nausea, vomiting, itching, micturition problems, and bladder catheterization during D0 and D1. Epidural administration of morphine-clonidine significantly improved postoperative pain relief and reduced piritramide consumption as compared to epidural bupivacaine-clonidine. Side effects did not differ between groups except for a higher incidence of micturition problems in Group M during D1. The occurrence of bladder catheterization was not significantly higher in that group. We conclude that a low dose of epidural morphine combined with clonidine offers a better postoperative analgesia than does bupivacaine-clonidine. The excellent analgesic conditions were obtained at the expense of a higher incidence of difficulties in initiating micturition.     

Epidural morphine with butorphanol for postoperative analgesia after cesarean delivery

Epidural morphine has been used more and more to provide long-lasting postoperative analgesia after cesarean delivery. However, the incidence of pruritus (20%-93%) and nausea (17%-60%) detract from the usefulness of epidural morphine. The purpose of this study was to evaluate, in 30 patients having epidural anesthesia for cesarean delivery, the analgesic efficacy and side effects when a combination of epidural morphine, a mu-receptor agonist, and butorphanol, a mu-receptor antagonist and kappa-receptor agonist, was administered. After clamping of the umbilical cord, patients received 4 mg epidural morphine with 3 mL of normal saline (group 1), 4 mg epidural morphine with 1 mg butorphanol and 2 mL of normal saline (group 2), or 4 mg epidural morphine with 3 mg butorphanol (group 3). Patients were monitored for 24 h after administration of the study medications. There were no significant differences between the groups in visual analogue pain scores, time to first analgesic request, respiratory rate, or Trieger dot test performance in the 24 h immediately after these epidural injections. There were three patients in group 1 and one patient in group 2 who experienced oxygen saturations less than 90%. (No patients in group 3 developed an oxygen saturation less than 92%.) The patients in group 3 did not require treatment for pruritus or nausea, a response significantly different (P less than 0.001 and P less than 0.05, respectively) from group 1 or group 2.(ABSTRACT TRUNCATED AT 250 WORDS)