Comparison of analgesic effects of epidural morphine and epidural non-morphine drugs

硬膜外吗啡与硬膜外非吗啡药物镇痛效果比较

• 批准号: 08660379
• 负责人: NISHIMURA Ryohei
• 金额: $ 1.54万
• 依托单位: The University of Tokyo
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1998
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08660379/
• 关键词: opioid; morphine; analgesia; epidural; pain manegement; buprenorphine; bupivacaine; butorphanol; 鎮痛薬; 内臓痛; 体性痛; メデトミジン; ミダゾラム

This study was designed to develop the clinically effective epidural non-morphine for post-operative analgesia and the followings are the results and conclusion.1) Epidural morphine was effective for both somatic and visceral pain in rat model. In contrast, epidural administration of medetomidine (a sedative), midazolam (a tranquilizer), ketamine (an anesthetic), and non-morphine opioids(butorphanol and buprenorphine)induced only mild to moderate analgesia. The combinations of these drugs except for morphine were not also very effective for analgesia.2) Epidural administration of high dose of local anesthetics(lidocaine and bupivacaine)induced potent analgesia, however the duration of analgesia was short and caused severe ataxia of pelvic limbs. The combinations of low dose of bupibavacaine and butorphanol or buprenorphine induced potent analgesia against either somatic or visceral pain without apparent ataxia. These combinations, especially the combination of bupivacaine and buprenorphine may be a substitute of morphine when used epidurally.3) Epidural morphine or bupivacaine and buprenorphine were effective for post-operative pain management in clinical cases that were underwent various surgery. Although the higher dose of bupivacaine than the dose which was estimated from the results obtained above was needed, epidural bupivacaine and buprenorphine caused mild ataxia in dog cases. In conclusion, epidural bupivacaine and buprenorphine is effective for post-operative analgesia in dogs.

本研究旨在开发临床有效的硬膜外非吗啡用于术后镇痛，结果和结论如下：1)硬膜外吗啡对大鼠模型的躯体和内脏疼痛均有效。相比之下，硬膜外给予美托咪定（镇静剂）、咪达唑仑（镇静剂）、氯胺酮（麻醉剂）和非吗啡阿片类药物（布托啡诺和丁丙诺啡）仅引起轻度至中度镇痛。除吗啡外，这些药物的联合用药镇痛效果也不是很好。2)硬膜外给予大剂量局麻药(利多卡因、布比卡因)镇痛效果较强，但镇痛持续时间短，且造成盆腔肢体严重共济失调。低剂量布比巴卡因与布托啡诺或丁丙诺啡的组合可诱导针对躯体或内脏疼痛的有效镇痛，而没有明显的共济失调。这些组合，特别是布比卡因和丁丙诺啡的组合，在硬膜外使用时可以替代吗啡。3)硬膜外吗啡或布比卡因和丁丙诺啡对接受各种手术的临床病例的术后疼痛管理有效。尽管需要比根据上述结果估计的剂量更高的布比卡因剂量，但硬膜外布比卡因和丁丙诺啡在狗病例中引起轻度共济失调。总之，硬膜外布比卡因和丁丙诺啡对于犬的术后镇痛是有效的。