硬膜外单次剂量缓释吗啡（DepoDur^TM）与硬膜外普通吗啡用于剖宫产术后镇痛的比较  

作　　者：Brendan Carvalho Laura M. Roland Larry F. Chu Vincent A. Campitelli Edward T. Riley 冯鲲鹏(译) 米卫东(校) 

机构地区：[1]Department of Anesthesia, Stanford University School of Medidne, Stanford, California [2]不详

出　　处：《麻醉与镇痛》2008年第4期85-93,共9页Anesthesia & Analgesia

摘　　要：背景椎管内单次剂量硫酸吗啡可以为剖宫产术后提供良好的镇痛；但是，其疗效仅限于手术后l天。在近期的一项Ⅲ期研究中，与常规硬膜外吗啡相比，缓释硬膜外吗啡（EREM）为剖宫产手术后提供了更有效、更长时间的镇痛。然而，该研究方案不允许使用非甾体抗炎药物（NSAIDs），却使用了多种手术后镇痛药物，对于呼吸抑制的监测和治疗也没有标准化。我们进行本研究的目的是在更具代表性的妇科临床条件下，比较在剖宫产手术后使用EREM与硬膜外普通吗啡，两者在术后镇痛药用量、疼痛评分及副作用方面的差异。方法这项随机、双盲研究中纳入了70例接受择期剖宫产手术的健康产妇。采用腰．硬联合阻滞技术，蛛网膜下腔注入布比卡因12mg和芬太尼10斗g。在关闭腹膜后，硬膜外单次注射普通吗啡4mg或EREM10mg。所有患者手术后每6小时口服布洛芬600mg，如果出现爆发痛，可口服氢考酮或者静脉注射吗啡。手术后48小时内，监测患者的脉搏氧饱和度和呼吸情况。结果无论在静息时还是活动状态，单剂EREM均可显著改善疼痛评分。EREM组与常规硬膜外吗啡组相比，剖宫产手术后48小时内追加的阿片类药物用量（以吗啡等效剂量表示）中位数（四分位数间距）由17（22）mg降至10（17）mg（P=0．037）。两组药物均有良好耐受性且在不良反应方面无明显差异。结论EREM与普通吗啡相比，能够为剖宫产术后提供更好更持久的镇痛，而不良反应未见明显增加。BACKGROUND： A single-dose of neuraxial morphine sulfate provides good post-Cesarean analgesia; however, its efficacy is limited to the first postoperative day. In a recent phase Ⅲ study, extended-release epidural morphine （ER- EM） formulation provided more effective, prolonged analgesia after Cesarean delivery, compared to conventional epidural morphine. However, the study protocol did not allow for the use of nonsteroidal antiinflarnmatory drugs, used various postoperative analgesics, and monitoring and treatment of respiratory depression were not standardized. Our aims in this study were to compare postoperative analgesic consumption, pain scores and side effects of EREM with conventional morphine for the management of post-Cesarean pain in a setting more reflective of current obstetric practice. METHODS： Seventy healthy parturients undergoing elective Cesarean delivery were enrolled in this randomized, double-blind study. Using a combined spinal epidural technique, patients received an intrathecal injection of bupivacaine 12 mg and fentany110 mcg. After closure of the fascia, a single-dose of either conventional morphine 4 mg or EREM 10 mg was administered epidurally. Postoperatively, all patients received ibuprofen 600 mg orally every 6 h. Oral oxycodone and IV morphine were available for breakthrough pain. All patients received pulse oximetry and respiratory monitoring for 48 h post-Cesarean delivery. RESULTS： Single-dose EREM significantly improved pain scores at rest and during activity. The median （interquartile range） of supplemental opioid medication usage for 48 h post-Cesarean （in milligram-morphine equivalents） decreased from 17 （22） to 10 （17） mg with ER- EM compared to conventional epidural morphine （P = 0. 037）. Both drugs were well tolerated with no significant difference in adverse event profiles. CONCLUSIONS： EREM provides superior and prolonged post-Cesarean analgesia compared to conventional epidural morphine with no significant increases in adverse events.

关 键 词：剖宫产术后镇痛 硬膜外吗啡 缓释吗啡 单次剂量 剖宫产手术后 非甾体抗炎药物 蛛网膜下腔注入 脉搏氧饱和度 

分 类 号：R971.2[医药卫生—药品] R656.6[医药卫生—药学]