全膝關節置換術後硬膜外嗎啡的鎮痛效果研究

Analgesic effect of epidural morphine after total knee arthroplasty

10.12408/J.issn2223-4462.2024.01.005

冼東鋒(XIAN Dong Feng)；吳朝興(NG Chio Heng)；廖婧(LIAO Jing)；吳俊晞(NG Chon Hei)；吳達星(WU Da Xing)；曹麗勤(CHO Lai Kan)

硬膜外鎮痛 ； 嗎啡 ； 全膝關節置換術 ； Epidural analgesia ； Morphine ； Total knee replacement

鏡湖醫學

24卷1期（2024 / 06 / 01）

17 - 19

繁體中文;英文

目的：本文對全膝關節置換術後病人硬膜外單次給予嗎啡的鎮痛效果進行了研究。方法：研究資料來自澳門鏡湖醫院，2021年4月～2022年8月60例全膝關節置換手術病人隨機分到試驗組（腰硬聯合麻醉：單次蛛網膜下腔注射0.5%布比卡因2-3ml+硬膜外注射嗎啡2mg）和對照組（單次蛛網膜下腔注射0.5%布比卡因2～3ml），兩組患者術中均行關節周圍浸潤。記錄患者術後0～6h、6～12h、12～24h、24～36h、36～48h的NRS（numerical rating scale）疼痛評分以及是否發生瘙癢、尿瀦留、噁心嘔吐、呼吸抑制。結果：與對照組相比，試驗組術後48小時內NRS評分≧4分發生率較低（20.0% [6/30] vs. 46.7% [14/30] P=0.028），試驗組尿瀦留發生率高於對照組（36.7% [11/30] vs. 6.7% [2/30] P=0.005）。結論：硬膜外小劑量嗎啡可以減少全膝關節置換術後病人中至重度疼痛發生率，但病人術後尿瀦留風險增加。

Objective: Objective: Patients often develop moderate to severe pain after total knee arthroplasty (TKA). This study compared the analgesic effect of single-dose epidural morphine with that of the control group in patients following TKA surgery. Methods: This randomized, double-blinded, controlled trial was conducted between April 2021 and August 2012. Sixty patients were randomized to receive either combined spinal epidural anesthesia (spinal anesthesia with 0.5% bupivacaine 2-3ml followed by epidural injection of 2 mg morphine, the experimental group) or spinal anesthesia (spinal anesthesia with 0.5% bupivacaine 2-3 ml, the control group). For all patients, periarticular infiltration with local anesthetic was performed. The severity of pain was assessed with the numerical rating scale (NRS) at 0-6, 6-12, 12-24, 24-36, and 36-48 hours after surgery. The presence of pruritus, urinary retention, nausea, vomiting, and respiratory depression was recorded. Results: The incidence of moderate to severe pain (NRS≥4) within 48 hours was lower in the experimental group than in the control group (20.0% [6/30] vs. 46.7% [14/30] P=0.028). The incidence of urinary retention was greater in the experimental group than in the control group (36.7% [11/30] vs. 6.7% [2/30] P=0.005). Conclusion: For patients following TKA, single-dose epidural morphine decreases the incidence of moderate to severe pain within 48 hours, but it increases the incidence of urinary retention.