鞘内应用吗啡预防硬膜穿刺后头痛
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Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache
背景与目的
硬膜穿刺术后硬膜外预防性应用吗啡已被证实能降低硬膜穿刺术后头痛的发生率。本研究假设鞘内预防性地应用吗啡可降低硬膜穿刺术后头痛的发生率和/或意外硬膜穿刺后需要硬膜外血补丁填充的概率。
方 法
本研究采用随机双盲法，对硬膜外腔置管分娩镇痛的患者，用17号穿刺针穿刺硬膜后，鞘内置管并进行观察研究。分娩后产妇随机接受鞘内吗啡150ug或等量生理盐水。主要结果是硬膜穿刺后头痛的发生率。次要结果包括硬膜穿刺后头痛的发作、持续时间和严重程度、颅神经症状的存在以及患者接受的治疗类型。
结 果
本研究共纳入61名产妇。硬膜穿刺后头痛的发生率：27例鞘内吗啡组产妇中有21例（78%），34例鞘内生理盐水组产妇有27例（79%）（-1%；95%CI：-25%-24%）；两组间头痛的发作、持续时间、严重程度或颅神经症状方面无差异。硬膜外血补丁填充：27例鞘内吗啡组产妇中有10名（37%）和21例鞘内生理盐水组产妇中有11名（52%）（15%；95%CI：-18%-48%）。
结 论
目前的研究结果表明，分娩后鞘内预防性给予150ug的吗啡并不会降低意外硬膜穿刺后硬膜穿刺头痛的发生率或严重程度。
原始文献摘要
Feyce M. Peralta, Cynthia A. Wong, Nicole Higgins；Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache；Anesthesiology 2020; XXX:00–00
Background: Prophylactic epidural morphine administration after unintentional dural puncture
with a large-bore needle has been shown to decrease the incidence of post–dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post–dural puncture headache and/or need for epidural blood
patch after unintentional dural puncture.
Methods: Parturients with an intrathecal catheter in situ after unintentional dural puncture with a 17-g Tuohy needle during intended epidural catheter placement for labor analgesia were enrolled in this randomized, double-blind trial. After delivery, subjects were randomized to receive intrathecal morphine 150 µg or normal saline. The primary outcome was the incidence of post–dural puncture headache. Secondary outcomes included onset, duration, and severity of post–dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received.
Results: Sixty-one women were included in the study. The incidence of post–dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, −1%; 95% CI, −25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve
symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, −18% to 48%).
Conclusions: The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease the incidence or severity of post–dural puncture headache after unintentional dural puncture. This study does not support the clinical usefulness of prophylactic intrathecal morphine after an unintentional dural puncture.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：冯玉蓉 审校：王贵龙