負荷劑量嗎啡對恢復室成人急性疼痛控制的成效某醫學中心回溯分析

Effects of A Loading Dose of Morphine for Postoperative Pain Relief in Adult Patients in Post-Anesthetic Care Unit: A Retrospective Analysis in A Medical Center

手術結束前投予負荷劑量嗎啡，預期可以改善恢復室急性疼痛控制品質，本回溯試驗之目的在於探討其成效。研究設計：探用回溯分析為期…年之恢愎堂紀錄，病患依施予負荷劑量嗎啡0.05mg / kg為區分為兩群，接受負荷劑量嗎啡患者為試驗組，沒有接受負荷劑量嗎啡患者為控制組4成效評估包括：疼痛控制（痛分）、到達與離開恢復室之痛分，給予救援止痛藥頻率，嗎啡消耗量以及術後併發症。實驗結果：分析了從PACU離開的11048名成人患者的資料，到達恢復室嚴重疼痛分的百分比，試驗組（19.4%）明顯比控制組低（37.7%）。離開恢復業疼痛緩解的百分比，試驗組（86.1%）也明顯比控制組有高（72.9%）。嗎啡消耗量，試驗組（5.9土2.0mug）比控制（7.4±3.5mg），顯著減少。在恢復室期間給予救援鎮痛藥的頻率，試驗組（18.3%）也明顯比控制組低（21.7%）。術後合併症的發生率兩組沒有顯著差異。研究結論：手術結束前給予負荷劑量嗎啡可改善恢復室之急性疼痛控制品質而且不會增加術後嚴重併發症之發生。

A loading dose of morphine administered before intravenousmorphine titration might improve acute pain relief in the post-anesthesia care unit(PACU). The purpose of this study was to evaluate the effect of a loading dose ofmorphine retrospectively. Materials and methods: We reviewed a one-year intervalPACU records. Patients were divided into two groups, those who received aloading dose (0.5mg/ks) before the end of surgery (group L) and those who did not(group C). Postoperative pain was assessed using the numerical rating scale (NRS;0 to 10), and a score of >3 required another administration of morphine in thePACU. NRS was measured every 15 min up to discharge. Main outcomesevaluations included NRS, morphine consumption, rescue analgesics andincidence of postoperative adverse events. Results: Complete data of 11,048 adultpatients discharged from PACU were analyzed. Initial NRS >7 occurred lessfrequently in group L than group C (19.4% vs 37.7%, p<0.001). NRS <3 atdischarge also showed favorable result in group L (86.1% vs 72.9%, p<0.01). Themean equivalent morphine consumption was significantly lower in the group Lthan group C (5.9 2.6 vs 7.4 3.5mg, p<0.05). The incidence of requiring rescueanalgesics was lower in study group (18.3 vs 21.7%, p<0.01). The incidences ofpostoperative events did not differ significantly between groups. Conclusion: Aloading dose of morphine before morphine titration provided better acute paincontrol in PACU. This improvement was not associated with more postoperativeadverse events.