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Effective Intrathecal Dose of Dose of Morphine for Postoperative Pain Relief in Transurethral Resection of Prostate

經尿道前列腺切除術後使用脊椎內嗎啡注射之有效劑量

摘要


背景:自1995年來我們一直以脊椎內注射0.2mg嗎啡作為剖腹生產術後止痛之用。在去年(2001)十二月起我們嘗試以同劑量之嗎啡與方式應用在經尿道前列腺切除術之病患身上,但止痛效果奇差。因此,我們嘗試用不同劑量之嗎啡應用在經尿道前列腺切術之病患身上以求出最有效果與最少副作用之止痛劑量。方法:45名ASA I或II之病患,在常規性半身麻醉下,經尿道切除前列腺手術,隨機分為三組,每組15人。A組接受0.5% bupivacaine 10mg與0.5mg morphine之混合物。B組接受0.5% bupivacaine 10mg與1mg morphine之混合物。而C組則接受0.5% bupivacaine 10mg與1.5mg morphine之混合物。在手術結束回病房後開將記錄病患訴說疼痛時的時間及病患任何不適情形。結果A組病患在手術後4-6小時間開始投訴有痛感;B、C兩組的止痛時間均長達24小時。而C組比B組的止痛時間還長。在惡心嘔吐方面,C組比B組出現較多次數次輕微惡心嘔吐現象。至於延遲性呼吸抑制現象則未見發生。結論:脊椎內注射1mg嗎啡應用在經尿道前列腺切除術後止痛方面是為最適當之劑量。

關鍵字

止痛 有效劑量 脊椎內嗎啡

並列摘要


Background: In December 2001 we used 0.2mg intrathecal morphine at the same dose as in post cesarean analgesia for transurethral resection of prostate (TUR-P) cases but this technique was not effective. This study assessed the analgesic effectiveness of an intrathecal morphine dose in the rang from 0.5 to 1.5 mg. Methods: A total of 45 ASA I or II patients scheduled for TUR-P surgery were randomly assigned to three groups. Group A patients served as reference and were anesthetized by intrathecal injection of 0.5% bupivacaine (20mg/4mL/amp) 10 mg and 0.5 mg morphine 10mg/mLamp). Group B and C patients underwent the same anesthetic procedure but morphine was injected simultaneously at a dose of either 1mg (Group B) or 1.5 mg (Group C). Results: Group A patients experienced postoperative pain for 4 to 6 hours and required a mean intravenous dose of 50 mg of meperidine. Group B and C patients had a satisfactory degree of analgesia. Nevertheless, there was no significant difference in the analgesia scores between groups C and B. None of the patients in these groups developed respiratory impairment, but Group C had a higher number of patients with delayed vomiting than the other groups. Conclusion: This study found that 1 mg of intrathecal morphine appeared to be the optimal dose for analgesia after TUR-P.

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