Continuous Epidural Morphine and Lidocaine for Postoperative Pain Control in Obstetric and Gynecologic Operation

持續性硬腦膜外腔灌注Morphine及Lidocaine用於婦產科手術後止痛

馮勁驃(Bill King-Piu Fung) ； 紀歐惠(Alfhild Jensen Gislefoss) ； 何師竹(Esther Shih-Chu Ho)

《Acta Anaesthesiologica Sinica》 32卷4期 (1994/12) Pp. 247-250

摘要

Background: Postoperative wound pain is a remarkable distress and may precipitate major complication. We attempted to develop a reliable and effective technique for postoperative analgesia that is safe and simple enough to be provided in an ordinary ward of a rural hospital. Materials and Methods: A retrospective study of continuous epidural infusion of morphine 7.5 mg in 60 ml diluted lidocaine for postoperative pain control in 156 patients in the past year was undertaken. Among the patients, one hundred and twelve patients had undergone Cesarean Section, and 44 patients had uterine or adnexal operations. All patients received epidural anesthesia. Results: Effective analgesia was achieved in all cases throughout the postoperative period. Pain relief was long lasting and there were only 5 patients (3.2%) who required some additional narcotics. The mean interval between completion of the operation and passage of flatus was 33.2 h. Only 48 patients (30.8%) complained of skin itching, 39 patients (25.0%) reported nausea and vomiting and 62 cases (39.7%) experienced constipation. Urinary retention after Foley catheter removal was noted in 9 cases (5.8%). No major complication pertaining to the technique was encountered. Conclusions: We concluded that continuous epidural infusion of morphine and diluted lidocaine is an effective, simple and safe technique for postoperative pain control in obstetric and gynecologic operation and it can be administered routinely even in a rural hospital.

關鍵字

Continuous postoperative epidural analgesia: morphine ； lidocaine

並列摘要

傷口疼痛是外科手術後揮之不去的痛苦，並可能因此而引致重要的合併症，我們試圖發展一種可靠而有效的術後止痛方法，足以簡單而安全地在鄉村醫院的普通病房內施行。在過去一年中，埔里基督教醫院麻醉科爲156位接受硬腦膜外腔麻醉術的婦產科病患，提供手術後持續性硬腦膜外腔Morphine 7.5mg及稀釋Lidocaine 60mL貫注止痛術，其中112人接受剖腹生產，44例子宮或骨盤腔內手術。根據回顧性的研究，在整個手術結束後時期，全數案例都得到有效的疼痛治療，止痛時效亦很長，只有5人（3.2%）仍需要一點止痛藥。從手術結束至病人排氣的時間平均爲33.2小時，62人（39.7%）有便秘現象，48例（30.8%）感到皮膚搔癢，39人（25.0%）有噁心或嘔吐的情形，拔除導尿管後仍有排尿困難者則有9人（5.8%），施行本止痛術並未引起嚴重的合併症。我們的結論認爲，對婦產科手術後病人而言，持續性硬腦膜外腔Morphine及稀釋Lidocaine貫注，是一種有效，簡單而安全的止痛方式，甚至在鄉村的醫院都能常規性地實行。