The Evaluation of Subarachnoid Adminstration of Fentanyl for Surgery and Postoperative Analgesia in Patients Undergoing Cesarean Section

蜘蛛網膜內給予Fentanyl應用於產科脊椎麻醉的評估

伍乙棠(Yuet-Tong Ng) ； 陳捷(Chit Chen) ； 蔡榮財(Eng-Chye Chuah) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 28卷4期 (1990/12) Pp. 438-442

https://doi.org/10.6955/AAS.199012.0438

摘要

The use of spinal opioids for postoperative analgesia has gained popularity in recent years. In this study, subarachnoid fentanyl 20 μg was evaluated to determine its efficacy for postoperative analgesia, Its possible side effects and its effects on the newborn. Sixty ASA class I or II at-term parturients undergoing elective cesarean section were randomly divided into two groups. In one group fentangl 20 μg (0.4 ml) with 0.5% heavy marcaine 2.0 ml was given intrathecally and in the other group only as heavy marcalne 2.0 ml with CSF 0.4 ml was given intrathecally. The average time for patients in the fentanyl group to demand the first dose of narcotic for pain was 6.8 ± 3.2 h and in the control group it was 39 ± 1-1 h. The Incidences or postoperative nausea and vomiting were higher in the fentanyl group than in the control group. Pruritus was only found in the fentanyl group and amounted to 50%. Early or late respiratory depression was not found in the fentanyi group, During operation, all patients were wakeful and alert. Neonatal condition as determined by and Apgar score was satisfactory and showed no significant difference in both groups. Examination on neurobehavior reflexes done at the baby room showed no abnormality in both groups.

並列摘要

脊椎內給予鴉片類藥物用作手術後止痛法近年來愈趨流行，本研究報告主要在探討給予蜘蛛網膜下腔fentanyl 20㎍對孕婦止痛療效；副作用及對新生兒的影響作一評估。把六十名準備作帝王手術孕婦分為兩組，其中一組給予0.5％ heavy marcaine 2 ml及fentanyl 20 μg（0.4 ml）而另一組給予0.5% heavy marcaine 2 ml及回抽脊髓液0.4 ml。所得結果顯示，在fentanyl組孕婦需要産後第一止痛劑時間平均為6.8±33小時，而只用heavy marcaine組孕婦需要第一針止痛時間平均為3.9±1.1小時。手術後有噁心，嘔吐現象在fentanyl組孕婦要較marcaine組孕婦來得高。皮膚搔癢情況在fentanyl組孕婦中高達50％，但没有孕婦需要naloxone治療。呼吸抑制的早發生及晚發生情況在fentanyl組孕婦都没有出現，且病人在手術當中都完全清醒，新生兒出生後用Apgar score一分鐘及五分鐘評估，兩組都没有顯著差異；在嬰兒室的神經行為反射檢查並没有不正常。

並列關鍵字

Subarachnoid oplate ； Fentanyl ； Postoperative analgesia