분만통을 위한 Morphine과 Fentanyl의 척수강내 투여

Abstract

Intrathecal morphine can provide goad analgesia for the first stage of labor. However, a long latency, high incidence of side effects, and lack of perineal anesthesia limit its usefulness. We wished to make a short the latency and reduce the dose of morphine, administered morphine 0.2 mg, 0.3 mg, combined with fentanyl 25 micrograms intrathecally. Forty-five laboring patients were studied and randomly divided into two groups' group I (n=24) received intrathecal morphine 0.2 mg with fentanyl 25 ug; group II (n=21) received intrathecal morphine 0.3 mg with fentanyl 25 ug; We compared the analgesia and side effects of group I to those of group II. Analgesia was assessed using the 100 mm visual linear analog(VLA) as the time elapsed from the drug administration to the delivery. The onset of analgesia was rapid(within 5 minutes) in both groups and VLA scores did not differ at any observation point between the groups. The effect of analgesia was lasted until the perineum was distended by the fetus. The incidence of nausea or vomiting was 41.7%(10/24) in group I, and 33.3%(7/21) in group II. Pruritus occured 87.5%(21/24)) in group I and 90.5%(19/21) in group II. The majority of pruritus occured soon after administration of study drug. There were more instances of urinary retention in group II (61.9%) than in group I(37.5%). No patient developed postdural puncture headache, vital sign alteration or respiratory depression. Most of all the patients in this study said that they were satisfied with this analgesic technique and would like to receive intrathecal narcotic analgesia for future labor. With the above results we conclude that intrathecal morphine 0.2 mg with fentanyl 25 ug for labor pain provides rapid and effective analgesia as 0.3 mg intrathecal morphine with fentanyl 25 ug.