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。     

蛛网膜下隙注射吗啡术后镇痛

目的　探讨蛛网膜下隙注射吗啡术后镇痛的临床效果及不良反应。方法　ASAⅠ～Ⅱ级 6 0例择期妇科手术病人 ,随机分为两组 ,每组 30例 ,均采用腰麻 硬膜外联合阻滞。腰麻用药为0 5 %重比重布比卡因 10mg ,然后硬膜外腔置管。研究组于腰麻药中加入吗啡 0 2 5mg ,对照组则于硬膜外腔注射吗啡 2mg。术后行视觉模拟评分 (VAS)、Ramsay镇静评分、BCS(Bruggrmanncomfortscale)舒适评分并观察不良反应发生情况。结果　蛛网膜下隙吗啡组术后完全无痛时间和持续镇痛时间明显长于硬膜外吗啡组 ,VAS评分明显低于硬膜外吗啡组 (P <0 0 5或P <0 0 1)。Ramsay评分和BCS评分明显高于硬膜外吗啡组 (P <0 0 5或P <0 0 1)。蛛网膜下隙吗啡组术后不良反应发生率明显增加 (P <0 0 5 )。结论　蛛网膜下隙注射吗啡镇痛效果确切、持续时间长 ,但不良反应发生率较高于硬膜外吗啡镇痛     

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。     

吗啡复合布比卡因蛛网膜下腔麻醉用于妇科术后镇痛的观察

腰-硬联合穿刺减少了传统的单纯蛛网膜下腔穿刺易引起头痛等神经系统并发症的发生。本研究旨在观察不同剂量吗啡复合布比卡因蛛网膜下腔麻醉用于妇科手术的麻醉和术后镇痛的效果和不良反应。资料与方法一般资料选择卵巢囊肿剥除术或子宫肌瘤剜除术患者75例,年龄20～50岁,身高158～170cm,体重45～65kg,ASAⅠ或Ⅱ级,术前无明显循环、呼吸及神经内分泌系统疾病。随机分为0.1mg吗啡组、0.3mg吗啡组和0.5mg吗啡组三组,每组25例,分别用0.1、0.3和0.5mg吗啡(0.2ml)复合布比卡因13.5mg(0.75%,1.8ml)作为蛛网膜下腔麻醉用药,并加入10%高渗葡萄糖1.0…     

罗哌卡因复合舒芬太尼蛛网膜下腔麻醉在剖宫产术中的应用

目的探讨罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射在剖宫产术中的应用。方法将120例择期行剖宫产术产妇随机均分3组:A组为0.75%罗哌卡因10 mg。B组为0.75%罗哌卡因10 mg复合舒芬太尼3μg。C组为0.75%罗哌卡因10 mg复合舒芬太尼5μg。经L2-3行腰—硬联合麻醉,留置硬膜外导管备用。记录3组产妇麻醉效果,感觉和运动阻滞程度和时间,术中血流动力学变化和不良反应、新生儿apgar评分及硬膜外追加局麻药情况。结果 3组均安全完成手术,最高感觉阻滞平面、运动阻滞程度及恢复时间、新生儿apgar评分差异无统计学意义。麻醉优良率C组>B组>A组,但皮肤瘙痒的例数C组>B组>A组,C、B 2组镇痛时间长于A组(P<0.05),3组产妇生命体征变化差异无统计学意义,均无呼吸抑制发生。硬膜外追加局麻药的例数A组明显高于C、B 2组(P<0.05)。结论罗哌卡因复合舒芬太尼蛛网膜下腔麻醉效果满意,术后镇痛时间长,不良反应少,可安全用于剖宫产术。     

不同浓度罗哌卡因蛛网膜下腔麻醉在肛周手术中的应用

探讨不同剂量罗哌卡因蛛网膜下腔阻滞麻醉在肛周手术中的效果。选择蛛网膜下腔阻滞麻醉下行肛周手术的患者93例,随机分为三组,每组31例。A组:采用0.75%罗哌卡因2.0 mL;B组:采用0.5%罗哌卡因2.0 mL;C组:采用0.25%罗哌卡因2.0 mL。观察并记录麻醉起效时间、麻醉效果、术后运动阻滞及尿潴留发生情况。三组患者感觉阻滞起效时间及麻醉优良率比较差异无统计学意义(P0.05)。术毕时下肢运动阻滞0~I级者:A组(31/31,100.0%)和B组(10/31,32.3%)明显高于C组(4/31,12.9%,P0.05)。尿潴留发生率:C组(2/31,6.5%)明显低于A组(7/31,22.6%)和B组(11/31,35.5%,P0.05)。采用0.25%罗哌卡因2.0 mL蛛网膜下腔阻滞麻醉行肛周手术,麻醉效果确切、下肢运动神经阻滞轻且尿潴留发生率低。     

不同稀释容量的吗啡对术后镇痛的影响

目的　探讨不同稀释容量的吗啡对剖宫产患者术后镇痛的影响。方法　 80例行剖宫产术患者 ,随机分成四组 ,每组 2 0例。A组 :吗啡 1 5mg稀释到 2ml;B组 :吗啡 1 5mg稀释到 5ml;C组 :吗啡 1 5mg稀释到 10ml;D组 :吗啡 1 5mg稀释到 2 0ml;分别在手术结束时注入硬膜外腔。术后6 ,12和 2 4小时用视觉模拟评分法 (VAS)评定镇痛效果并观察恶心、呕吐、瘙痒和呼吸抑制等并发症。结果　四组病人 2 4小时内VAS评分在任何时间均无明显差异 (P >0 0 5 ) ,仅D组恶心、呕吐、瘙痒发生率大于A、B和C组。结论　不同稀释容量的吗啡对术后镇痛无明显影响     

硬膜外和蛛网膜下腔吗啡术后镇痛诱发呼吸抑制的观察

硬膜外和蛛网膜下腔吗啡术后镇痛诱发呼吸抑制可危及生命。我们自 1993年以来 ,遇到呼吸抑制病人 12例 ,现总结如下。资料与方法选择 ASA ～ 级拟在硬膜外麻醉或腰麻 -硬膜外联合麻醉下行中下腹部、下肢手术病人。术前安静状态下脉搏氧饱和度 (Sp O2 ) <96 %或全麻病人被排除。符合条件的病人中硬膜外吗啡术后镇痛 780例 ,蛛网膜下腔吗啡术后镇痛 2 2 0例。术前 0 .5 h肌注苯巴比妥钠 0 .2 g,硬膜外穿刺 ,术中以 2 %利多卡因 0 .3%地卡因 1:1混合液维持麻醉 ,术毕硬膜外吗啡首次负荷剂量 1.5～ 2 mg,维持量 PCEA6 0～ 80 μg/h,辅助…     

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。     

罗哌卡因复合吗啡蛛网膜下腔麻醉用于下肢骨科手术的临床观察

下肢手术常采用蛛网膜下腔麻醉,罗哌卡因是常用的局部麻醉药;吗啡是经典的阿片类镇痛药,常用于术后镇痛.本研究观察采用罗哌卡因复合吗啡蛛网膜下腔麻醉用于下肢骨科手术及术后镇痛的效果. 资料与方法 一般资料选择手术时间在2h以内的单侧下肢骨科手术患者40例,ASAⅠ或Ⅱ级,男22例,女18例,年龄35～65岁,身高158～180 cm,体重48～80kg,无椎管内麻醉禁忌证,无心、肺、肝、肾功能不全.患者随机均分为A、B两组.     

Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery

Laparoscopic surgery has become popular in recent years, but few studies have addressed analgesia for this type of surgery. We conducted a prospective double-blind randomised trial on 36 cases of laparoscopic colorectal surgery to determine the influence of intrathecal morphine on postoperative pain relief. All patients received a subarachnoid block with local anaesthetic in addition to general anaesthesia. One group also received intrathecal morphine. A patient-controlled analgesic (PCA) device was prescribed for pain control postoperatively and the visual analogue score (VAS) was used for pain assessment. The group who received intrathecal morphine used significantly less morphine. There were no adverse cardiovascular effects of the combined anaesthetic technique. Nausea and vomiting remained the main side-effect of intrathecal morphine but this was easily treated with anti-emetics.     

Epidural morphine and neostigmine for postoperative analgesia after orthopedic surgery

In this study, we examined the side effects and analgesia of the combination of epidural neostigmine and morphine in patients undergoing orthopedic surgery. Sixty patients undergoing knee surgery were divided into four groups. The intrathecal anesthetic was 15 mg of bupivacaine. The epidural test drug was diluted in saline to a final volume of 10 mL. The control group received saline as the epidural test drug. The morphine group received 0.6 mg of epidural morphine. The neostigmine group (NG) received 60 micro g of epidural neostigmine. The morphine/neostigmine group received 0.6 mg of epidural morphine combined with 60 micro g of epidural neostigmine. The groups were demographically the same and did not differ in intraoperative characteristics. The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among groups (P > 0.05). One patient from the NG complained of intraoperative nausea, closely related to spinal hypotension. Postoperatively, two patients from the NG had vomited once. The time (min) to first rescue analgesic was longer in the morphine/neostigmine group ( approximately 11 h) compared with the other groups (P < 0.05). The analgesic consumption (number of analgesic administrations in 24 h) was larger in the control group compared with the other groups (P < 0.05). IMPLICATIONS: The combination of epidural morphine and epidural neostigmine resulted in postoperative analgesia (11 h) devoid of side effects, being an alternative analgesic technique in the population studied.     

Comparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects

Background and Objectives. Epidural morphine is accepted as an efficient means of postoperative pain management. However, development of side effects such as nausea and vomiting and pruritus has been reported. This study compared the efficacy of intravenous infusions of nalbuphine or naloxone in the prevention of epidural morphine-related side effects. Methods. Seventy-five female patients undergoing epidural anesthesia for total hysterectomy were enrolled in a randomized, double-blind study. At the end of the surgery, all patients received epidural 3 mg morphine (every 12 hours) for postoperative pain. Meanwhile, patients in group 1 received an adjuvant intravenous infusion of nalbuphine 60 μg/kg/h, patients in group 2 received intravenous infusion of naloxone 2 μg/kg/h, and patients in group 3 received intravenous saline infusion only. A rescue analgesic of intramuscular 50 mg meperidine (every 4 hours) was available for each patient. Patients were observed for 24 hours. Results. All patients had adequate postoperative pain relief. However, the proportion of patients requiring rescue analgesia and the total consumption of rescue analgesic were higher in group 2 than in the other two groups. The incidence of nausea and vomiting and pruritus was higher in group 3 than in the other two groups. Conclusions. We found that coadministration of either nalbuphine or naloxone with epidural morphine reduces the incidence of morphine-related side effects. However, unlike naloxone, nalbuphine did not attenuate the analgesic effect of epidural morphine.     

Effect of continuous epidural infusion of morphine on postoperative glucose metabolism

Plasma growth hormone (GH), insulin, prolactin and blood glucose levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in 16 patients who underwent gastrectomy. Continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia) was given to eight (epidural morphine group) patients. A bolus of epidural morphine was administered through an indwelling thoracic (Th8.9) catheter at 3 hrs prior to the expected end of surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042 mg.hr-1 with the pump during and after anesthesia and surgery with gradually decreasing dose until the third postoperative day. The remaining eight patients (systemic analgesics group) repeatedly received intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma GH levels increased significantly only on the first postoperative day in both groups. Plasma insulin levels increased significantly on the first postoperative day in both groups. Blood glucose levels increased significantly at the end of surgery and during the following three postoperative days in both groups. There are no statistical differences in plasma GH, insulin and blood glucose levels between the two groups. Plasma prolactin concentrations increased significantly at the end of surgery and they were significantly higher in the systemic analgesic group than in the epidural morphine group. They, however, returned to the previous day's levels on the first postoperative day in both groups. Our study suggests that continuous epidural infusion of morphine has no suppressing effect on postoperative changes in plasma GH, insulin, prolactin and blood glucose levels as compared with systemic analgesic regimen.     

Oral clonidine premedication enhances postoperative analgesia by epidural morphine

This study was designed to evaluate the effects of oral clonidine premedication on postoperative analgesia by epidural morphine in a prospective, randomized, double-blinded design. Sixty consenting patients, scheduled for total abdominal hysterectomy, were randomly assigned to one of three groups (n = 20 each); the clonidine-morphine group received oral clonidine 5 microg/kg 90 min before arriving in the operating room and epidural morphine 2 mg before induction of general anesthesia, the clonidine-placebo group received oral clonidine 5 microg/kg and no epidural morphine, and the placebo-morphine group received no clonidine and epidural morphine 2 mg. An epidural catheter was placed at the L1-2 or L2-3 interspace, and 1.5% lidocaine was used for surgical anesthesia in all patients. General anesthesia was then induced with propofol, and maintained with a continuous infusion of propofol and 67% nitrous oxide in oxygen during surgery. Four patients were subsequently withdrawn from the study. After surgery, patient-controlled analgesia using IV morphine was used to assess analgesic requirement. Morphine consumptions determined every 6 h after surgery in the clonidine-morphine and placebo-morphine groups were significantly less than the clonidine-placebo group until 12 h after surgery, whereas those of the clonidine-morphine group were significantly less than the placebo-morphine group from 13 to 42 h after surgery. Visual analog (pain) scale (VAS) scores in the clonidine-morphine group were significantly lower than the placebo-morphine group at 48 h at rest, and at 1, 24, 36, and 48 h with movement. Similarly, VAS scores in the clonidine-morphine group were significantly lower than the clonidine-placebo group at 1 and 6 h both at rest and with movement, whereas VAS scores in the clonidine-placebo group were significantly lower than the placebo-morphine group at 24, 36, and 48 h at rest and with movement. The incidence of nausea and pruritus was similar between groups. We conclude that the combination of oral clonidine and epidural morphine produces more potent and longer lasting postoperative analgesia than either drug alone without increasing the incidence of adverse effects after major gynecologic surgeries. IMPLICATIONS: A small dose of epidural morphine is often used for postoperative analgesia. We found that oral clonidine premedication 5 microg/kg improves the analgesic efficacy of epidural morphine without increasing the incidence of adverse side effects.     

Thoracic epidural clonidine and morphine for postoperative pain relief

This study was undertaken to evaluate the potentiation of the postoperative analgesic effect of thoracic epidural morphine by coadministration of thoracic epidural clonidine in a randomized double-blinded design. Twenty patients underwent radical gastrectomy under combined general anaesthesia (enflurane and nitrous oxide/oxygen) and epidural anaesthesia with local anaesthetics. They received a thoracic epidural bolus injection of either 0.05 mg · kg^?1 morphine plus 3 μg · kg^?1 clonidine (M+C group; n =10) or 0.05 mg · kg^?1 morphine alone, (M group; n = 10) immediately before completion of surgery. All patients received iv morphine via patient-controlled analgesia (PCA) equipment for 24 hr postoperative period, and the PCA iv consumption of morphine was the primary variable of efficacy of the analgesic regimen. In addition, data analyses included mean arterial blood pressure, heart rate, respiratory rate, arterial blood gas measurement, sedation score, and visual analogue pain scale score (VAS). The cumulative number of iv morphine injections via PCA was less in the M+C group than in the M group at each hour for 24 hr postoperative period (P < 0.05), while the numbers of PCA morphine injections per hour beyond nine hours after surgery were higher in the M group than in the M+C group (P < 0.05). Sedation score was higher, and VAS and mean blood pressure were lower in the M+C group only at one hour after surgery compared with the M group. We conclude that the combined single thoracic epidural administration of morphine plus clonidine produces a more potent and longer lasting analgesia than does morphine alone.     

Peridural opiate analgesia. Clinical results of a 2-year study

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.     

Does Epidural Morphine Loading in Addition to Thoracic Epidural Analgesia Benefit the Postoperative Management of Morbidly Obese Patients Undergoing Open Bariatric Surgery? A Pilot Study

Background

Insufficient data exist regarding postoperative thoracic epidural analgesia for morbidly obese patients undergoing open bariatric surgery. This study evaluated the effectiveness of morphine loading in a postoperative thoracic epidural analgesic regimen of patient-controlled epidural analgesia (PCEA) with levobupivacaine combined with continuously administered epidural morphine in this patient group.

Methods

In this prospective randomized controlled trial, 48 superobese patients (body mass index of ≥50 kg/m²) undergoing open bariatric surgery were randomly allocated to three groups of 16 patients each. Postoperatively, all groups received a continuous epidural morphine infusion of 0.2 mg/h with 0.1 % levobupivacaine via PCEA. Group A did not receive intraoperative epidural morphine loading, while groups B and C received an intraoperative 1- and 2-mg morphine bolus, respectively. Levobupivacaine consumption via PCEA (primary outcome), pain scores at rest and on cough, the time to return of bowel function and ambulation, and arterial blood gas levels (secondary outcomes) were recorded.

Results

The increase in perioperative morphine administration (groups B and C) led to a significantly prolonged return to normal bowel function and delayed ambulation (P?Conclusions Thoracic PCEA with 0.1 % levobupivacaine combined with continuous epidural morphine administration of 0.2 mg/h without morphine loading is an effective postoperative analgesic regimen that provides adequate pain control, early ambulation, and early return of bowel function in superobese patients, particularly those with OSA.     

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...