- 期刊
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
Pre-and Intra-operative Administration of Epidural Morphine Provides Good Postoperative Pain Relief after Laminectomy
摘要
目的：以硬脊膜外嗎啡及lidocaine溶液，經由不同的給藥時機，應用於腰椎推間板切除術的病患，評估其術後止痛的效果。方法：本院於過去半年內，收集了84位ASA體位分等第I-II級接受腰椎手術的病患，隨機分成三組，group I(n = 17)為對照組，使用非固醇類術後靜脈止痛劑(diclo-phenac sodium 50 mg, iv, q4h); group II (n = 36)病人於全身麻醉前，在病灶部位(L_(4-5)或L_5-S_1)脊椎間的硬脊膜外腔中，一次注入morphine 3 mg + 2% lidocaine至10 ml溶液；在確定沒有蜘蛛網膜下腔注射(intrathecal injection)並且產生了分節式阻斷(segmental blockade)之後，再行全身麻醉。Group III(n = 31)病人於手術過程當中，在病灶矯治後、傷口關閉前，直接將morphine 3 mg + 2% lidocaine 3ml 滴入病灶處的硬脊膜外腔中。手術後以視覺類推疼痛級數(visual analog pain score, VAS)記錄病人的疼痛程度及副作用。結果: Group II及III的止痛效果比group I(對照組)好(II及III之間無統計上差異);group II及III有較高的副作用(如噁心、嘔吐及皮癢)，臨床上沒有出現呼吸抑制。結論：腰椎手術的病人不論是於手術前，在病灶部位脊椎間的硬脊膜外腔中注入嗎啡及lidocaine溶液，或是於術中直接將嗎啡及lidocaine溶液滴入病灶處的硬脊膜外腔中，其止痛效果都令人滿意。對於疼痛度高的腰椎手術後止痛而言，此兩種方法均不失為一簡單且有效的止痛方式。
並列摘要
Background: To evaluate the postoperative analgesic effect of epidural morphine administered at different timing in lumbar spine surgery. Methods: Eighty-four patients who were scheduled for elective lumbar spine surgery were randomized in three groups. Seventeen patients in group I who received non-steroid analgesics postoperatively (diclophenac sodium 50 mg, iv, q4h) served as control while thirty-six patients in group II who received single dose epidural morphine 3 mg in combination with 10 ml 2% lidocaine given at the lesion site (L_4-5 or L_5-S_1) just before general anesthesia and thirty-one patients in group III who received 3 mg morphine in combination with 3 ml 2% lidocaine administered to the targeted epidural space by means of slow drippings just before wound closure were studied subjects. Results: During the first 24 h postoperatively, the patients in group II and group III suffered a pain which was significantly less in intensity as compared with those in group I (p ＜ 0.05). We used the 10 cm visual analog pain score (VAS) to scale post-operative pain with ＂no pain＂ and ＂worst pain＂ respectively anchored at 0 and 10 cm. The incidence of side effects such as pruritus, nausea and vomiting was higher in group II and III than in group I. We did not evaluate the occurrence of urinary retention because routine retention urinary catherization in all patients hampered us to do so. There were no significant differences in the quality and duration of analgesia between group II and III. Respiratory depression of clinical significance was not observed. Neither decrease in oxygen saturation below 92% registered on pulse oximetry nor decrease in respiratory rate below 12 cycles/min was found in the PACU. Conclusions: Preoperative or intraoperative administration of epidural morphine could provide satisfactory analgesia in lumbar spine surgery during the first 24 h postoperatively.
延伸閱讀
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