Effects of a Loading Dose of Morphine for Postoperative Pain Relief in Adult Patients in Post-Anesthetic Care Unit: A Retrospective Analysis in a Medical Center

負荷劑量嗎啡對恢復室成人急性疼痛控制的成效－某醫學中心回溯分析

盧偉(David-Vi Lu) ； 黃瑞眉(Jui-Mei Huang) ； 謝佳芳(Chia-Fang Shieh) ； 李雅惠(Ya-Hui Lee) ； 林淑芬(Shu-Fen Lin) ； 張邇寧(Chang Erh Ning) ； 陳玉蘭(Yu-Lan Chen) ； 湯振青(Chen-Chin Tang) ； 陳俊道(Chun-Dao Chen) ； 錢懿(Chien I)

《疼痛醫學雜誌》 19卷1期 (2009/03) Pp. 1-7

https://doi.org/10.29792/TTJP.200903.0001

摘要

背景及目的：手術結束前投予負荷劑量嗎啡，預期可以改善恢復室急性疼痛控制品質，本回溯試驗之目的在於探討其成效。
研究設計：採用回溯分析為期一年之恢復室紀錄，病患依施予負荷劑量嗎啡0.05mg/kg為區分為兩群，接受負荷劑量嗎啡病患者為試驗組，沒有接受負荷劑量嗎啡病患者為控制組。成效評估包括：疼痛控制（痛分）、到達與離開恢復室之痛分、給予救援止痛藥頻率、嗎啡消耗量以及術後併發症。
實驗結果：分析了從PACU離開的11048名成人患者的資料。到達恢復室嚴重疼痛分的百分比，試驗組(19.4%)明顯比控制組低(37.7%)。離開恢復室疼痛緩解的百分比，試驗組(86.1%)也明顯比控制組有高(72.9%)。嗎啡消耗量，試驗組(5.9±2.6mg)比控制組(7.4±3.5mg)，顯著減少。在恢復室期間給予救援鎮痛藥的頻率，試驗組(18.3%)也明顯比控制組低(21.7%)。術後合併症的發生率兩組沒有顯著差異。
研究結論：手術結束前給予負荷劑量嗎啡可改善恢復室之急性疼痛控制品質，而且不會增加術後嚴重併發症之發生。

關鍵字

嗎啡 ； 術後疼痛 ； 恢復室

並列摘要

A loading dose of morphine administered before intravenous morphine titration might improve acute pain relief in the post-anesthesia care unit (PACU). The purpose of this study was to evaluate the effect of a loading dose of morphine retrospectively. Materials and methods: We reviewed a one-year interval PACU records. Patients were divided into two groups, those who received a loading dose (0.5mg/ks) before the end of surgery (group L) and those who did not (group C). Postoperative pain was assessed using the numerical rating scale (NRS; 0 to 10), and a score of ＞3 required another administration of morphine in the PACU. NRS was measured every 15 min up to discharge. Main outcomes evaluations included NRS, morphine consumption, rescue analgesics and incidence of postoperative adverse events. Results: Complete data of 11,048 adult patients discharged from PACU were analyzed. Initial NRS ＞7 occurred less frequently in group L than group C (19.4% vs 37.7%, p＜0.001). NRS ＜3 at discharge also showed favorable result in group L (86.1% vs 72.9%, p＜0.01). The mean equivalent morphine consumption was significantly lower in the group L than group C (5.9±2.6 vs 7.4±3.5mg, p＜0.05). The incidence of requiring rescue analgesics was lower in study group (18.3 vs 21.7%, p＜0.01). The incidences of postoperative events did not differ significantly between groups. Conclusion: A loading dose of morphine before morphine titration provided better acute pain control in PACU. This improvement was not associated with more postoperative adverse events.

並列關鍵字

Morphine ； postoperative pain ； post-anesthesia care unit