芬太尼吗啡联合用于罗哌卡因蛛网膜下腔阻滞和术后镇痛

目的随机双盲对照研究比较剖宫产手术中使用芬太尼和吗啡单独或联合进行罗派卡因蛛网蟆下腔阻滞效果差别。方法99例择期在0．75％罗哌卡因7．5mg蛛网膜下腔阻滞行剖宫产手术的产妇随机分配到三组；F组在蛛网膜下腔同时给与芬太尼15^ug，M组给与吗啡0．25mg，FM组给与芬太尼150^ug＋吗啡0．25mg，所有的产妇在手术以后给与病人自控镇痛系统（PCA）进行吗啡术后镇痛。结果各组在术中舒适度、麻黄碱消费量、恶心呕吐、瘙痒和镇静等方面没有显著的差异（p〉0．05）；F组和FM组与M组之间相比取得感觉阻滞效果时间有显著差异（p〈0．05）；F组和M组以及F和FM组之间，吗啡术后镇痛消耗量在4，8，12和24小时有显著的差异（p〈0．01），在2小时点，F组和FM组之间已有显著差异（p〈0．05）。结论与单独使用芬太尼比较，蛛网膜下腔吗啡与芬太尼合用可以提供更加良好的术后镇痛，与单独使用吗啡相比，蛛网膜下腔吗啡与芬太尼合用可以更快的建立阻滞平面；结果表明不同给药途径吗啡单独使用在手术后均能够提供良好的镇痛。

A Comparison of Intrathecal Fentanyl and Morphine as Adjuncts in Ropivacaine Spinal Anesthesia for Caesarean Section

objective This randomized controlled trial examines the effect of fentanyl and morphine,alone and in combination,as adjuncts to spinal anesthesia for caesarean section.Methods Ninety-nine women undergoing Elective Caesarean Section with spinal anesthesia using 0.75% hyperbaric Ropivacaine 7.5mg were randomly allocated to receive fentanyl 15ug(F),morphine 0.25mg(M),of fentanyl 15ug plusmorphine 0.25mg(FM),intrathecally.All women received morphine via a patient controlled analgesia system after surgery.RESULTS compared with M group,F and Fm groups had significant difference in time to achieve a block.There was no significant difference between the groups in discomfort,use,nausea and vomiting,pruritus and sedation during surgery.Significant differences were observed in Morphine consumption 4,8,12 and 24 hours after surgery between both F and M groups,and F and FM groups,and also at 2 hours between F and FM groups.Conclusions Our results suggest that morphine alone provides optimum benefits during and after surgery and fentanyl alone provides faster block achieving time.When used in combination with hyperbaric Ropivacaine for Caesarean section,all above effect could be achieved simultaneously with no increase of side-effect.