小儿骶管复合用药对术后镇痛的影响

目的观察小儿骶管复合用药对术后镇痛的影响。方法80例1～4岁患儿随机分为四组,每组20例。在静脉麻醉后行1%利多卡因1ml/kg骶管阻滞:Ⅰ组局麻药中不加其他药,Ⅱ组加芬太尼2μg/kg,Ⅲ组局麻药中加新斯的明2μg/kg,Ⅳ组局麻药中加曲马多2mg/kg。术后给予芬太尼护师控制泵注镇痛(NCA)治疗。分别于术后1、2、4、6、24h观察镇痛和镇静评分,记录镇痛时间(初次NCA)、NCA芬太尼用量、不良反应及出院时间。结果Ⅳ组的镇痛时间(510.7±64.9)min,长于Ⅰ组的(174.5±39.3)min、Ⅱ组的(291.7±50.8)min和Ⅲ组的(242.0±62.8)min(P0.01)。但Ⅳ组术后恶心呕吐的发生率高于其他三组(P0.05)。结论2mg/kg曲马多复合1%利多卡因1ml/kg行小儿骶管阻滞的术后镇痛效果较好,但其恶心呕吐发生率也有所增加。

Effects of lidocaine caudal block with medications on postoperative analgesia in children

Objective To investigate the effects of caudal block with lidocaine plus drugs on postoperative analgesia in children. Methods Eighty children aged 1 to 4 years old received caudal block with 1% lidocaine 1 ml/kg and were randomly allocated to 4 groups with 20 cases each. The local anesthetic solution was added fentanyl 2 μg/kg in group Ⅱ , neostigmine 2 μg/kg in group Ⅲ, tramadol 2 mg/kg in group Ⅳ or nothing in group Ⅰ. Postoperative analgesia with fentanyl (nurse controlled analgesia, NCA) was given in all patients. Pain and sedation scores were evaluated at 1, 2, 4, 6 and 24 h after surgery. The duration of caudal analgesia, fentanyl requirements, sicle effects,and discharge time were recorded. Results Duration of caudal analgesia in group Ⅳ was (510. 7±64. 9)rain, which was longer than (174.5±39. 3) rain in roup Ⅰ , (291.7 ± 50. 8) min in group Ⅱ , or (242.0±62. 8) min in group Ⅲ. The incidence of postoperative nausea and vomiting was more requent in group Ⅳ than that in the other groups(P<0. 05). Conclusion Combined 1 % lidocaine 1 ml/kg with tramadol 2 mg/kg for caudal block can provide better and longer postoperative analgesia, but with a higher incidence of postoperative nausea and vomiting.