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題名 | Comparison of Subcutaneous Hydromorphone with Intramuscular Meperidine for Immediate Postoperative Analgesia=皮下注射Hydromorphone與肌肉注射Meperidine在恢復室中止痛效果的比較 |
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作者 | 詹偉弘; 林珍榮; 孫維仁; 蔡素碧; 蔡勝國; 謝長堯; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 15:7 1999.07[民88.07] |
頁次 | 頁419-427 |
分類號 | 418.224 |
關鍵詞 | 止痛藥; 皮下注射; 肌肉注射; 恢復室; 止痛; Hydromorphone; Meperidine; Postoperative pain; |
語文 | 英文(English) |
中文摘要 | 肌肉注射meperidine在臺灣是一種常見的術後止痛方式,但是廣泛使用卻有許多爭議。Hydromorphone是一種強效鴨片類止痛藥,最大的特色是具有皮下注射快速收的便利性。儘管皮下注射hydromorphone在歐美地區已經廣泛使用,但是過去與肌肉注射meperidine比較的研究仍然付之闕如。本實驗即卻比較兩者在成年中國人做為術後止痛劑的效力,安全性及病患對給藥方式的滿意度的差異。六十位接受腹部全子宮切除的女性病患隨機等分為兩組:當病患在麻醉恢復室甦醒並要求止痛時,分別給予hydromorphone 1毫克皮下注射,或meperidine 50毫克肌肉注射。在注射前後記錄其visual analogue score(VAS),同時觀攛副作用的發生,以及詢問對注射方式的滿意度,當病患回病房後,即開始使用病患自控式止痛裝置,記錄24小時內使用狀況。在疼痛指數及疼痛緩解度兩者並無顯著差別。副作用方面:噁心、嘔吐、嗜睡的程度以及排氣時間在二組之間並無顯著差異,但暈眩的情形在meperidine組較顯著。兩組均無呼吸抑制的情形發生。病患首次使幅控式止痛給藥的時間兩組之間沒有差異,二十四小時內嗎啡使用總量,病患要求及給藥的次數上均無明顯差異。病患對皮下注射的滿意度顯著較高。和肌肉注射50毫克meperidine相比,皮下注射1毫克hydromorphone不僅提供同樣的快速而強效的止痛療效,更具有較輕微的鴉片類止痛藥副作用的優點,而且病患對皮下注射的方式也擁有較高的滿意度。因此我們建議hydromorphone皮下注射應可做為meperidine肌肉注射之外,麻醉恢復室中的另一種止痛方式。 |
英文摘要 | Intramuscular (IM) injection with meperidine is the most common analgesic approach to treat postoperative pain in Taiwan. Hydromorphone (Dilaudid) can provide very potent and rapid analgesic effect through subcutaneous (SC) injection. Although hydromorphone is widely used in North America, no study had compared the analgesic efficacy, side effect profiles and patients’ satisfaction with the method of injection of hydromorphone SC and meperidine IM for the immediate post-op-erative analgesia. In this randomized and double-blind study, 60 female patients scheduled for abdominal total hysterectomy were treated either with 1 mg hydromorphone SC (n=30) or 50 mg meperidine IM (n=30) when they regained consciousness and asked for analgesic treatment in the recovery room. Visual analogue score (VAS) of wound pain was obtained at 0, 10 and 30 min after injection by a blinded observer. The occurrence and severity of nausea, vomiting, dizziness, drowsiness, flatus passage and respiratory depression were recorded. Post-opera-tive analgesia in the ward was maintained by patient-controlled analgesia (PCA) with intravenous morphine. Time to first PCA demand, the number of demands, delivery, delivery/demand ratio and 24h morphine consumption were documented. We found that VAS was reduced at 10 min and , to a greater extent, at 30 min postinjection in both groups but with no significant difference between the two groups. The occurrence and severity of side effect profiles were similar in both groups except that dizziness was more frequently observed after meperidine injection. Delivery, demand, delivery/demand ratio and 24 hr morphine consumption by PCA were not significantly different between the two groups. Time to first PCA trigger was also similar. Patients receiving hydromorphone SC injection exhibited higher satisfactory score than those receiving meperidine meperidine IM injection. Hydromorphone 1mg, injected subcutaneously, was as effective as intramuscular meperdine 50 mg while permitting more favorable injection technique and fewer side effects. We suggest that subcutaneous hydromorphone is a good alternative to intramuscular meperidine for postoperative analgesia in the recovery room. |
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