- 期刊
Thoracic Epidural Analgesia with Morphine Does Not Prevent Postthoracotomy Pain Syndrome: A Survey of 159 Patients
胸椎硬膜外嗎啡止痛不能預防開胸術後疼痛症候群：159位病人之回溯性研究
摘要
背景：研究為回溯開胸手術病人，顴察術後疼痛症候群之發生率，并研究以硬膜外嗎啡止痛劑是否對出現術後疼痛現象有預防效果。 方法：我們檢閱372位開胸手術病人，這些病人手要時大多為全身麻醉(GA)輔以胸椎硬膜外止痛劑(TEA)，其中只有159位病人(42%)可參與研究；依疼痛持續的時間將159位病人分成兩組：疼痛組（疼痛超過3個月，人數為65位）或不痛組（疼痛不超過3個月，人數為94位）。 結果：比較兩組病人之性別、年齡、體重、身高、抽煙與否、飲酒狀況、教育程度、婚姻狀況、手術持續時間及手術時接受全身麻醉輔以胸椎硬膜外止痛劑(GA+TEA)與只接受全身麻醉(GA)數目之比，發現大約41%的病人出現術後疼痛症候群(PTPS)其疼痛持續的時間為21±12個月（追蹤期：28±12個月），這些病人大多只是輕度到中度的疼痛，其主述多為“不舒服”。只有6.2%病人經歷到刺痛、持續疼痛、燒灼痛或麻木等嚴重的疼痛。而這些有出現術後疼痛症候群之病人比較會發生沮喪及失眠等情形。至於術後疼痛現象之發生率在只接受全身麻醉(GA)與全身麻醉輔以胸椎硬膜外止痛劑(GA+TEA)之病人并無統計上有意義的差別（39%比42%）。 結論：手術後持續三天輔以胸椎硬膜外嗎啡止痛并沒有預防PTPS效果。
並列摘要
Background: This retrospective study sought to determine the incidence of postthoracotomy pain syndrome (PTPS), and whether epidural morphine for the postoperative analgesia could prevent the development of PTPS. Methods: We reviewed the charts of 372 patients who had undergone thoracotomy. The majority underwent general anesthesia (GA) combined with thoracic epidural analgesia (TEA). Of the 372 patients, only 159 (42%) were available for interview. Patients were divided into two groups based on the duration of pain, i.e., pain group (pain＞3 months, n=65) and pain-free group (pain＜3 months, n=94). Results: Both groups were comparable regarding sex, age, weight, height, smoking, alcohol ingestion, education, marital status, duration of surgery, and the number of patients either receiving GA plus TEA or GA alone. About 41% of the patients experienced PTPS that persisted for 21±12 mon (follow-up: 28±12 mon). Most pain was mild or moderate and was usually described as being only a discomfort. Only 6.2% suffered severe pain with shooting, aching, burning or numbness. Patients with PTPS suffered more depression and insomnia. The incidence of PTPS was not different in patients who received GA alone or GA plus TEA (39% vs. 42%). Conclusions: Epidural morphine for postoperative analgesia that continued for 3 days appeared to have no effect in the prevention of PTPS.
延伸閱讀
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