Dosage of epidural morphine analgesia after lower abdominal cancer surgery: a randomized clinical trial among the older adults.

IF 2 3区 医学 Q2 ANESTHESIOLOGY
Muhammad Shawqi, Sahar Abdel-Baky Mohamed, Essam Sharkawy, Diab Hetta
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Abstract

Background: Epidural morphine is considered one of the most potent drugs used for postoperative analgesia; however, its side effects are dose-related and exaggerated in elderly people. In this study, we aimed to determine which of three doses within that range (1.5 mg, 3 mg, or 4.5 mg) can provide adequate pain relief.

Methods: A total of 102 patients were assessed for allocation into one of four groups to receive either placebo (group Morphine 0, N = 22), 1.5 mg of epidural morphine (Morphine 1.5, N = 22), 3 mg of epidural morphine (Morphine 3, N = 22), or 4.5 mg of epidural morphine (Morphine 4.5, N = 22) before skin incision, 24 h after surgery and 48 h after surgery. Cumulative intravenous IV-PCA morphine consumption, VAS pain scores, modified Ramsay Sedation Scores, nausea, vomiting, and pruritus were evaluated.

Results: The VAS pain scores at activity of patients who received epidural morphine at doses of 3 mg and 4.5 mg were significantly lower than the placebo and 1.5 mg groups, VAS Score at 72 h was (2 ± 0.8) and (1.7 ± 1) vs (4.3 ± 1.1) and (4 ± 1) respectively, p value = 0.000. The mean total IV-PCA morphine consumption (mg) was significantly higher in patients who received received epidural 0.9% sodium chloride alone compared to 1.5 mg, 3 mg and 4.5 mg epidural morphine groups (38.1 ± 4.8 mg vs 27.2 ± 5.6 mg, 9.2 ± 3.5 mg, and 6.3 ± 3.3 mg respectively), p value = 0.000). However, the difference between the 3 mg and the 4.5 mg groups was not statistically significant in both of VAS scores and IV-PCA morphine consumption (P value > 0.05 for 3 mg vs. 4.5 mg). Patients who received 4.5 mg of epidural morphine experienced a significant increase in the level of sedation, measured by the Ramsay sedation scale, in comparison with 1.5 mg, 3 mg and placebo epidural morphine groups in the first 24 h, the Scale for this group was (2.5 ± 0.5) vs (2.1 ± 0.2, 2.1 ± 0.2, and 2.2 ± 0.5 respectively); p value = 0.000. No relationship between postoperative nausea and the dosage of epidural morphine was found.

Conclusion: Epidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.

下腹部肿瘤手术后硬膜外吗啡镇痛剂量:老年人随机临床试验。
背景:硬膜外吗啡被认为是术后镇痛最有效的药物之一;然而,它的副作用是剂量相关的,并且在老年人中会被夸大。在这项研究中,我们旨在确定在该范围内(1.5 mg, 3 mg或4.5 mg)的三种剂量中哪一种可以提供足够的疼痛缓解。方法:将102例患者分为4组,分别在皮肤切开前、术后24 h和术后48 h给予安慰剂(吗啡0组,N = 22)、硬膜外吗啡1.5 mg(吗啡1.5,N = 22)、硬膜外吗啡3 mg(吗啡3,N = 22)、硬膜外吗啡4.5 mg(吗啡4.5,N = 22)。评估静脉IV-PCA吗啡累积用量、VAS疼痛评分、改良Ramsay镇静评分、恶心、呕吐和瘙痒。结果:硬膜外吗啡3、4.5 mg组患者活动时VAS疼痛评分显著低于安慰剂组和1.5 mg组,72 h VAS评分分别为(2±0.8)、(1.7±1)vs(4.3±1.1)、(4±1),p值= 0.000。与硬膜外吗啡1.5 mg、3 mg和4.5 mg组相比,单纯使用0.9%氯化钠组IV-PCA吗啡的平均总用量(mg)显著高于硬膜外吗啡组(分别为38.1±4.8 mg vs 27.2±5.6 mg、9.2±3.5 mg和6.3±3.3 mg), p值= 0.000。然而,在VAS评分和IV-PCA吗啡用量方面,3 mg组与4.5 mg组的差异无统计学意义(3 mg组与4.5 mg组的P值为0.05)。使用Ramsay镇静量表(Ramsay sedsescale)测量,与1.5 mg、3 mg和安慰剂组相比,接受4.5 mg硬膜外吗啡组患者在前24 h的镇静水平显著升高,该组的评分分别为(2.5±0.5)vs(2.1±0.2、2.1±0.2和2.2±0.5);P值= 0.000。术后恶心与硬膜外吗啡剂量无关系。结论:老年人下腹部肿瘤手术后,硬膜外吗啡3mg / 24 h,加用患者自控镇痛(PCA)吗啡,按需给药1.5 mg,无背景输注,闭锁期45 min,可达到术后72 h的有效、充分的镇痛效果,且不增加镇静水平及其他副作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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自引率
3.80%
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