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題名 | Absence of the Preemptive Analgesic Effect of Dextromethorphan in Total Knee Replacement under Epidural Anesthesia=給予Dextromethorphan 肌肉注射於硬模外麻醉下執行全膝關節置換術可以降低術後疼痛,但不能提供前瞻性止痛 |
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作者 | 葉春長; 何善台; 孔祥珣; 吳慶堂; 汪志雄; Yeh, Chun-chang; Ho, Shung-tai; Kong, Shang-shung; Wu, Ching-tang; Wong, Chih-shung; |
期刊 | 麻醉學雜誌 |
出版日期 | 20001200 |
卷期 | 38:4 2000.12[民89.12] |
頁次 | 頁187-193 |
分類號 | 416.54 |
語文 | eng |
關鍵詞 | 全膝關節置換術; 術後疼痛; Dextromethorphan; Total knee replacement; Postoperative pain; |
中文摘要 | 背景:最近的研究已顯示dextromethorphan(DM),一種NMDA接受器的拮抗劑對手術病患具有前瞻性止痛的效果。本實驗的目的是檢測在單側全膝關節置換術的病人,接受肌肉注射DM是否也具有前瞻性止痛的效果。方法:本實驗選擇六十四位ASA Ⅰ-Ⅲ預備要接受單側全膝關節置換術的病人,隨機分為三組。所有三組病人皆接受硬膜外麻醉并且沒有術前給藥。術中給予15至20毫升的2%lidocaine以及每小時8毫升的維持劑量。在硬膜外導管放置前靜脈給予fentanyl(1.5μk/kg )及diazepam(2mg)。硬膜外導管在第二、三腰椎間或第三、四腰椎間往頭側置入5公分。封照組(C組)病人在術前接受肌肉注射(內含20毫克 chlorpheniramine)。B組及A組病人則分別在術前及術後給予肌肉注射40毫克DM。術後病人藉由病患自控止痛裝置接受靜脈注射morphine來止痛。術後我們共觀察72小時,并記錄病人第一次PCA按發的時間、morphine的總消耗量、最痛的分數、止痛劑引起的副作用。結果:第一次PCA按發的時間在A、B、C三組分別為61.8±7.2(與C組相較P<0.05)、67.3±11.1(與C組相較P<0.05)和31.2±5.2分鍾。休息時VAS最痛的分數在術後8小時,A、B、C三組分別為3.4±0.2(P<0.05)、3.7±0.2(P<0.05)、4.2±0.1及術後24小時,A、B、C三組分別為2.5±0.1(P<0.05)、2.4± 0.2(P<0.05),3.1±0.2。病患接受DM(40毫克)肌肉注射,VAS最痛的分數均較對照組為低,但A、B兩組并無差异。實際morphine給予量與PCA按發頻率之間在所有三組中72小時內并沒有明顯的差別。morphine引起的副作用在所有三組當中亦沒有明顯的統計意義。結論:我們發現肌肉注射DM(40毫克)對於硬膜外麻醉下執行全膝關節置換術的病人無法進一步提供前瞻性止痛。但相對於對照組病患,肌肉注射DM可提供較佳之止痛作用。 |
英文摘要 | Background: Previous studies have shown that dextromethorph an (DM), a N-methyl-D-aspartate(NMDA) re-ceptor antagonist, produces a preemptive analgesic effect on post-operative pain. The aim of this study was to further examine the pre emptive analgesic effect of intramuscular (i.m.) DM injection on unilateral total k nee re-placement (TKR). Methods : Sixty-four ASA Ⅰ-Ⅲ patients scheduled for unilateral TKR surgery were randomly al located into three groups in a prospective double-blind manner. All patients received epidural anesthesia with out anypremedi-cation. An initial bolus dose of 2% lidocaine (15–20 mL) followed by a maintenance dose of 8-10 mL/h was decide d. Fentanyl (1.5 μg/kg) and diaz epam (2mg) were given i.v. before epidural catheter insertion. The epidural catheter was placed via the L2-L3 or L3-L4 interspace and advanced for 5 cm cephaladly. Patients received i.m. injection of 20 mg chlorpheniramine (CPM) before surgery as control (group C, n=22). For the study groups, patients we re given an i .m . injection containing 40 mg DM an d 20 mg CPM, before (group B, n=22) or after surgery (group A, n=20), respectively. Postoperation, patients received intravenous morphine by means of a patient controlled an-algesia (PCA) device for pain relief. The time to the first pull of PCA trigger , morphine consumption , worse pain scores (resting and incidental), and analgesics related side effects were recorded at 1, 2, 4, 8, 24, 48 and 72 h after surgery. Results: The time from the end of operation to the first PCA trigger were 31.2 ± 5.2 min in group C, 67.3 ± 1 1.1 min in group B(P<0.05, com pared with group C) and 61.8 ± 7.2 min in group A(P<0.05, compared with group C) respectively. The relevant pain sc ore at resting, observed at the 8 h postoperatively was re spectively 4.2 ± 0.1 in group C, 3.7 ± 0.2 in group B(P<0.05, com pare d with group C) and 3.4 ± 0.2 in group A(P<0.05, compared with group C); and at the 24 h was 3.1 ± 0.2 in group C, 2.4 ± 0.2 in group B(P<0.05, compared with group C) and 2.5 ± 0.1 in group A(P<0.05, compared with group C) respectively. There were no significant differences in actual morphine delivery and frequency of PCA triggering at all time among the three groups. Moreover , there was al so no significant statistic difference in morphine-associated side effects among the three groups. Conclusions : In the present study, we failed to observe any preemptive analgesic effect of DM (40 mg, i.m.) on postoperative pain in patients who received TKR under epidural anesthesia, however , DM given either before or after surgery augmented other analgesic (morphine) to offer a better pain relief. |
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