- 期刊
Intermittent Bolus Versus Patient-Controlled Epidural Morphine for Postoperative Analgesia
使用嗎啡於間歇式硬脊膜外與病患自控式硬脊膜外術後止痛之比較
摘要
Background: Patient-controlled epidural analgesia (PCEA) is a technique that combines the flexibility and convenience of PCA with the intrinsic analgesic efficacy of epidurally administered opioids. The aim of this study is to compare the analgesic and side effects of intermittent bolus injections of epidural morphine with PCEA using morphine during the first 24 h after elective low abdominal surgery. Methods: Sixty patients were randomly assigned into two groups. Patients in group I (n = 30) received 3 mg epidural morphine at an 8-hour interval after surgery. Patients in group II (n = 30) received 2 mg epidural morphine after surgery and patient-controlled analgesia device was processed to deliver morphine 0.15 mg/h, 0.15 mg/bolus. All patients were observed for pain relief and adverse effects for 24 h. Results: Mean morphine consumption was 9 mg for epidural morphine group and 6.87 ± 0.27 mg for PCEA group. Although the PCEA group utilized significantly less morphine (p ＜ 0.05), pain and sedation scores were similar in the two groups. Pruritis occurred more frequently in the epidural morphine group (63%) than in the PCEA group (33%). Frequency and severity of nausea and vomiting were similar in the two groups. Conclusions: PCEA with morphine decreases morphine consumption and with less adverse effects than intermittent bolus of epidural morphine. PCEA with morphine is an acceptable alternative to epidural morphine after low abdominal surgery.
並列摘要
背景：比較常規下腹部手術後24小時，使用嗎啡於間歇式硬脊膜外方式與病患自控式硬脊膜外方式，兩者之止痛品質及副作用發生率。方法：60位病人平均且隨機地分成兩組，第一組於手術後每8小時接受3毫克硬脊膜外嗎啡，第二組於手術後接受2毫克硬脊膜外嗎啡，之後使用病患自控式裝置於硬脊膜外給予每小時0.15毫克及每次0.15毫克嗎啡，所有病人被觀察止痛效果及副作用24小時。結果：平均嗎啡消耗量在第一組是9毫克，第二組是6.87 ± 0.27毫克，雖然第二組明顯地使用較少嗎啡（p ＜ 0.05），但是兩組的疼痛及昏睡指數是相似的，在副作用方面，兩組在噁心及嘔吐的發生率及嚴重度是相似的，但在皮膚癢覺方面，第一組（63%）是比第二組（33%）有明顯較高的發生率。結論：使用嗎啡於病患自控硬脊膜外方式，其嗎啡的消耗量及副作用均比間歇硬脊膜外注射方式小，因此病患自控硬脊膜外注射嗎啡方式是一種可接受替代間歇式硬脊膜外注射嗎啡於下腹部手術後的止痛方式。