Mini-Dose Intrathecal Morphine for Post-Cesarean Section Analgesia

脊髓內微量嗎啡注射對剖腹生產後止痛之研究

江洽榮(Chung-Jong Jiang) ； 劉健強(Chien-Chiang Liu) ； 吳宗正(Tzong-Jeng Wu) ； 孫維仁(Wei-Zen Sun) ； 林仙養(Shiang-Yeang Lin) ； 黃芳彥(Fan-Yen Huang) ； 趙繼慶(Chi-Ching Chao)

《Acta Anaesthesiologica Sinica》 29卷4期 (1991/12) Pp. 683-689

摘要

Dose-response relationship of mini-dose intrathecal morphine (0.025-0.125 mg) for analgesia after Cesarean section was studied. Sixty-three patients were randomly divided into six groups by the following intrathecal morphine injection: group 1 (0 mg), group 2 (0.025 mg), group 3 (0.05 mg), group 4 (0.075 mg), group 5 (0.1 mg), and group 6 (0.125 mg). The selected dose of morphine mixed with 2 ml 0.5 % hyperbaric bupivacaine (10 mg) was administered intrathecally to induce spinal anesthesia. The mean analgesia duration in each group was 3.6±2.0, 10.6±7.1, 17.3±13.8, 25.6±7.5, 33.9±10.1, and 39.5±11.9 h respectively (mean±SD). In morphine groups, duration of analgesia was significantly longer (p ＜ 0.05) than control group (0 mg), and the first 24 h pain scores were also lower (p ＜ 0.01). Furthermore, a significant linear dose-response relationship between analgesic duration and the dose of intrathecal morphine was revealed (y =3.28 +295.5x, r^2 = 0.64, p ＜ 0.05). Among morphine groups, analgesic quality was significantly better in patients in groups 4-6 than those in group 2 and 3 (p ＜0.05), so as in the proportion of effective analgesia in the first 24 h (p ＜0.01). Neonatal condition was not adversely affected by such mini-dose of intrathecal morphine. The most common maternal adverse effect observed was pruritus, and its incidence was significantly greater in groups 3-6 than in the control group (p ＜ 0.05). However, no significant difference was observed among all morphine groups. No respiratory depression was found in all groups, while nausea, vomiting and sedation were not frequent and showed no significant difference among all morphine groups and control group. It is concluded that mini-dose intrathecal morphine (0.025-0.125 mg) provides a dose-dependent analgesia for post-Cesarean section pain with minimal adverse effect. In the present study, intrathecal morphine with dosage from 0.075 to 0.125 mg offered better analgesic effect with no significant unwanted reactions.

關鍵字

Cesarean section ； Analgesia: intrathecal, morphine ； Postoperative analgesia

並列摘要

於子宮切除與膽囊切除者經脊髓内微量嗎啡注射，已證實爲一有效之術後止痛方法，但於剖腹生產方面則尚無人探討。六十三位ASA體位分等第I-II級，接受常規剖腹生產的孕婦，隨機分爲六組，於脊髓麻醉之同時，分別給予0，0.025，0.005，0.075，0.100及0.125毫克的脊髓内嗎啡注射，以評估其對術後止痛之效果，副作用及對新生兒的影響。在止痛方面，各組的時效依次分別爲：3.6±2.0，10.6±7.1，17.3±13.8，25.6±7.5，33.9±10.1及39.5±11.5小時（mean±SD）；脊髓內嗎啡之劑量與止痛時效成正向之線性關係（y = 3.28 + 295.5x，r = 0.8，p ＜0.05）每一劑量之脊髓內嗎啡都能提供較對照組爲佳之術後止痛效果，然衡諸疼痛指數及二十四小時有效止痛之百外比，以0.075至0.125毫克之嗎啡三組與他組有顯著差異。在副作用方面，僅搔癢現象較好發於嗎啡組，新生兒的Apgar score於各組間亦無差異。結論認爲脊髓內微量嗎啡注射，對剖腹生產之孕婦可提供一有效且幾無副作用之術後止痛法；並且以0.075至0.125毫克之嗎啡能提供較長及較強之止痛效果，唯其副作用不會增加。