鞘内吗啡在非腹部手术中的应用：范围综述

BJA open Pub Date : 2025-03-20 DOI:10.1016/j.bjao.2025.100387

Aart Jan W. Teunissen , Lieke van Gastel , Robert J. Stolker , Seppe A. Koopman

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引用次数: 0

摘要

背景：鞘内吗啡可以减轻术后疼痛和阿片类药物的需求。它可以潜在地帮助提高非腹部手术的恢复方案的有效性。然而，对副作用的担忧可能阻碍了它的使用。本综述评估了鞘内吗啡在非腹部手术中的有效性、适当剂量和不良反应。方法我们系统地检索了检查鞘内吗啡在非腹部手术中的应用的随机对照试验。结果：检索确定了75项试验，涉及4685名患者。我们对这些随机对照试验进行了范围审查，包括偏倚评估，以全面分析鞘内吗啡的有效性和副作用。研究结果表明鞘内吗啡可减少脊柱手术、胸外科和骨科下肢手术后的疼痛和阿片类药物消耗。然而，它与瘙痒、术后恶心、呕吐和尿潴留的发生率增加有关，特别是在骨科手术中。在回顾的研究中，低至中等剂量（<500 μg）没有迟发性呼吸抑制。结论本综述支持鞘内吗啡在非腹部手术中的有效性。然而，必须仔细权衡这些好处和可能导致住院时间延长的潜在副作用。临床试验注册号prospero -registry CRD42021233936。

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The use of intrathecal morphine in non-abdominal surgery: a scoping review

Background

Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery.

Methods

We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery.

Results

The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (<500 μg) in the reviewed studies.

Conclusions

This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays.