以口服Morphine或Pentazocine作體外震波碎石術麻醉之止痛效果

The Analgesic Effect of Oral Morphine or Pentazocine for Extracorporeal Shock Wave Lithotripsy

背景：由於震波碎石術所使用之機型改良後，震波對人體造成之疼痛大為減輕，麻醉止痛之方式也因而不再侷限於傳統之全身麻醉，硬膜外腔麻醉或靜脈麻醉等。因此使得適當的口服止痛且併發較少的副作用成為必要考量。方法：我們選擇100位因泌尿道結石須接受體外震波碎石術(ESWL)之病人，任意區分為二組，每組各50人，分別給予不同之口服止痛劑加上鎮靜劑(lorazepam 1 mg)，觀察這二種口服止痛劑之效果及其副作用，並記錄血流動力及血氧之變化。本實驗病人所使用碎石機之機型為Dornier HM3改良型。口服止痛劑分別為 morphine 30 mg，及pentazocine 100 mg，均與lorazepam 1 mg溶於15 ml之開水中，於手術前30分鐘分別給各組病人服下，並於各選定時段觀察並記錄 相關指標，若病人不堪疼痛，則追加靜注fentanyl使手術繼續進行。結果：結果顯示，二組病人中，接受pentazocine 100 mg為口服止痛劑的病人，有94％能順利完成手術，不須追加任何靜注止痛劑，且其止痛程度──pain, sedation及efficacy scale之指數均令人滿意，在碎石過程中，病人之嗜睡反應也較理想，但眩暈之副作用，此組病人則呈現較高之比率。而接受morphine 30 mg的病人則68％之病人可以不需追加靜注止痛劑而完成手術，但噁心嘔吐副作用比例較高。血壓變化組內與組間均無差異，但給予pentazocine此組有較高心跳 和較低血氧飽和度之變化，但臨床上對病人均未產生明顯之症狀或需要加以處理。結論：我們認為對震波碎石術之止痛麻醉方式，若考慮成本效益及避免靜注麻醉劑過量之風險，單一口服止痛劑pentazocine 100 mg加上鎮靜劑lorazepam 1 mg，可以提供以新型高科技碎石機進行震波碎石術病人滿意之止痛效果。

Background: Extracorporeal shock wave lithotripsy (ESWL) in these days is usually carried out on ambulatory or outpatient basis. With the application of a lithotriptor of modern version an appropriate yet cost-effective analgesia with minimal side effects for ESWL is mandatory. Methods: The analgesic effect of oral morphine (30 mg) was compared with that of pentazocine (100 mg) in a prospective study comprising 100 patients undergoing ESWL with a lithotripter of improved version for urinary tract stones. All patients received orally lorazepam 1 mg as sedative together with the appointed tested drug 30 min before the procedure. The analgesic effects of both drugs were assessed having recourse to the pain scale and efficacy scale. Results: There were 94% of patients in the pentazocine (mixed agonist-antagonist) group who felt satisfied with the regimen and stood the procedure well without resort to supplemental drug, as compared with the morphine (potent μ-agonist) group in which only 70% of patients did so. Although the adverse effect such as dizziness was found in the pentazocine group, the degree of sleepiness produced by its deeper sedation effect was to the advantage of patients during the lithotripsy procedure. There were no significant changes in intergroup mean blood pressure (MBP), but heart rate (HR) was higher and O2 saturation (SpO2) was lower in the pentazocine group after treatment. Both narcotics did not induce renal colic in our study. Also, pentazocine 100 mg plus lorazepam 1 mg given orally did not induce psychotomimetic reaction intraoperatively or postoperatively. Conclusions: We concluded that oral pentazocine at 100 mg plus lorazepam 1 mg, could offer satisfactory analgesia in patients undergoing ESWL for urinary tract stones with a lithotripter of improved version.