氢吗啡酮用于剖宫产术后镇痛的ED50测定。

G. Lynde
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引用次数: 7

摘要

背景:吗啡是剖宫产术后鞘内镇痛最常用的阿片类药物,但持续的药物短缺导致可用性有限。一种建议的吗啡替代品是氢吗啡酮。研究其在剖宫产后镇痛中的应用是有限的。本研究旨在确定产后12小时鞘内氢吗啡酮的中位有效剂量。方法选取20例择期剖宫产的健康妇女作为研究对象。采用上下序贯法测定氢吗啡酮剂量。氢吗啡酮的研究剂量从6μg开始,根据前一个参与者的剂量12小时的疗效增加或降低2μg。疼痛评分<3/10视为成功,后续患者接受较低剂量。参与者接受0.5%布比卡因12.5mg、芬太尼25μg和研究剂量的氢吗啡酮单次鞘内注射。结果20名参与者中有10人在注射后12h报告了有效的氢吗啡酮剂量。根据参与者报告的视觉模拟疼痛评分<3/10,氢吗啡酮的中位有效剂量为4.6μg (95% CI 3.72至5.48μg)。没有观察到明显的副作用或不良结果。结论鞘内氢吗啡酮可有效替代吗啡治疗剖宫产后疼痛。术后12小时提供镇痛所需的鞘内氢吗啡酮剂量可能明显低于目前使用的剂量。应进一步研究确定鞘内氢吗啡酮用于术后疼痛缓解的最佳剂量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Determination of ED50 of hydromorphone for postoperative analgesia following cesarean delivery.
BACKGROUND Morphine is the most common opioid injected into the intrathecal space for postoperative analgesia following cesarean delivery, but ongoing medication shortages have resulted in limited availability. One proposed morphine alternative is hydromorphone. Studies investigating its use in post-cesarean analgesia are limited. This study was conducted to determine the median effective dose of intrathecal hydromorphone 12h postpartum. METHODS Twenty healthy women undergoing elective cesarean delivery were recruited into this study. Hydromorphone doses were determined using the up-down sequential method. The study dose of hydromorphone started at 6μg and was raised or lowered by 2μg depending on the 12-h efficacy of the preceding participant's dose. Pain scores of <3/10 were considered successful and the subsequent patient received a lower dose. Participants received 0.5% bupivacaine 12.5mg, fentanyl 25μg, and the study dose of hydromorphone as a single intrathecal injection. RESULTS Ten of 20 participants reported an effective hydromorphone dosage 12h post-injection. The median effective hydromorphone dosage was 4.6μg (95% CI 3.72 to 5.48μg) based on participants' reported visual analog pain scores of <3/10. No significant side effects or adverse outcomes were observed. CONCLUSION Intrathecal hydromorphone may be an effective alternative to morphine for post-cesarean pain management. The amount of intrathecal hydromorphone necessary to provide analgesia at 12h postoperatively may be significantly lower than doses currently in use. Further research should be performed to identify the optimal dose of intrathecal hydromorphone for post-surgical pain relief.
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