- 期刊
Reconsidering the Value of Intrathecal Morphine for Post-Cesarean Analgesia - A Rural Practice Experience
使用脊髓腔內嗎啡注射作剖腹產患者的術後止痛－偏遠地區的臨床經驗
摘要
Objective: The aim of this study was to assess the analgesic and side effects of intrathecal morphine in cases of elective cesarean section (C/S) in a hospital in rural Taiwan with a shortage of well-trained staff and adequate equipment. Material(s) and Method(s): A retrospective case-controlled study was done in 44 cases of elective C/S performed from May 1997 through December 1997 at the St. Mary’s Hospital in Taitung. The study group consisted of 22 patients who received an additional 0.2 mg morphine with intrathecal macaine anesthesia. The control group consisted of 22 patients who received routine spinal anesthesia with marcaine and 0.2 ml saline. All drugs used during hospitalization were analyzed. The frequencies of pethidine and/or non-steroid anti-inflammatory drug (NSAID) use for pain relief during the initial 24 hours after surgery were calculated to test the effects of intrathecal morphine. The drugs used to treat side effects were also compared between the two groups. Patient requests for any of the drugs mentioned above were calculated and evaluated according to burden on the nursing staff. Result(s): The age, parity, body weight, body height, incision wound, interval between the last C/S, and education level were similar in both groups. The frequencies of pethidine and/or NSAID use for pain relief after surgery were significantly reduced in the morphine group (4.7% versus 72.7%, P＜0.01 and 14.3% versus 86.4%, P＜0.01, respectively). In contrast, the incidence of anti-histamine drug use for pruritus relief was significantly increased (42.8% versus 0%, P＜0.01) in the study group. The study group asked significantly less post-operative injections than the control group (P＜0.01). Conclusion(s): In a rural practice with a shortage of manpower and facilities, intrathecal morphine might provide good analgesia during the initial 24 hours after elective C/S based on effectiveness and safety. However, unwanted side effects such as pruritus might interfere with routine recovery.
並列摘要
Objective: The aim of this study was to assess the analgesic and side effects of intrathecal morphine in cases of elective cesarean section (C/S) in a hospital in rural Taiwan with a shortage of well-trained staff and adequate equipment. Material(s) and Method(s): A retrospective case-controlled study was done in 44 cases of elective C/S performed from May 1997 through December 1997 at the St. Mary’s Hospital in Taitung. The study group consisted of 22 patients who received an additional 0.2 mg morphine with intrathecal macaine anesthesia. The control group consisted of 22 patients who received routine spinal anesthesia with marcaine and 0.2 ml saline. All drugs used during hospitalization were analyzed. The frequencies of pethidine and/or non-steroid anti-inflammatory drug (NSAID) use for pain relief during the initial 24 hours after surgery were calculated to test the effects of intrathecal morphine. The drugs used to treat side effects were also compared between the two groups. Patient requests for any of the drugs mentioned above were calculated and evaluated according to burden on the nursing staff. Result(s): The age, parity, body weight, body height, incision wound, interval between the last C/S, and education level were similar in both groups. The frequencies of pethidine and/or NSAID use for pain relief after surgery were significantly reduced in the morphine group (4.7% versus 72.7%, P＜0.01 and 14.3% versus 86.4%, P＜0.01, respectively). In contrast, the incidence of anti-histamine drug use for pruritus relief was significantly increased (42.8% versus 0%, P＜0.01) in the study group. The study group asked significantly less post-operative injections than the control group (P＜0.01). Conclusion(s): In a rural practice with a shortage of manpower and facilities, intrathecal morphine might provide good analgesia during the initial 24 hours after elective C/S based on effectiveness and safety. However, unwanted side effects such as pruritus might interfere with routine recovery.
延伸閱讀
- Sun, S. L., Cheng, K. W., Chien, C. C., Che, C. J., & Chang, C. F. (1990). 硬脊膜外腔嗎啡麻醉之体積對剖腹產手術後止痛之影響. Acta Anaesthesiologica Sinica, 28(4), 433-437. https://doi.org/10.6955/AAS.199012.0433
- 蔡志誠、蕭家亮、楊立卉、吳基烈（2010）。脊髓腔内嗎啡減痛法於非產科病人之應用－效果，副作用及滿意度。疼痛醫學雜誌，20(2)，54-58。https://doi.org/10.29792/TTJP.201009.0001
- 郭天縱、許榮廉、蘇崑山、黃志宏、李德南、程乃義、陳文昇（1996）。術前及術中經硬脊膜外腔注射嗎啡對椎間板切除術有良好之術後止痛效果。Acta Anaesthesiologica Sinica，34(2)，69-74。https://doi.org/10.6955/AAS.199606.0069
- Wu, Y. W., Seah, Y. S., Chung, K. T., & Liu, M. D. (1999). 初次剖腹產病人的術後止痛－經脊髓腔合併注射嗎啡及腎上腺素. Acta Anaesthesiologica Sinica, 37(3), 111-114. https://doi.org/10.6955/AAS.199909.0111
- Jiang, C. J., Liu, C. C., Wu, T. J., Sun, W. Z., Lin, S. Y., Huang, F. Y., & Chao, C. C. (1991). 脊髓內微量嗎啡注射對剖腹生產後止痛之研究. Acta Anaesthesiologica Sinica, 29(4), 683-689. https://www.airitilibrary.com/Article/Detail?DocID=P20170519003-199112-201902270006-201902270006-683-689