小儿硬膜外曲马多与吗啡术后镇痛的比较

Comparison of postoperative analgesia with epidural tramadol and morphine in children

目的比较氯胺酮基础麻醉下不同剂量的曲马多与吗啡的硬膜外镇痛效果。方法选择下腹和会阴部手术患儿80例,随机分为4组。对照组(C组,n=20)生理盐水3ml;吗啡组(M组,n=20)吗啡0.04mg/kg+氟哌啶0.03mg/kg;曲马多组Ⅰ(T1组,n=20)曲马多lmg/kg+氟哌啶0.03mg/kg;曲马多组Ⅱ(T2组,n=20)曲马多2mg/kg+氟哌啶0.03mg/kg,各组药物均在手术结束前单次硬膜外注入。采用疼痛5级评分法评价镇痛效果。结果C、M、T1、T2组镇痛效果均为优的时间分别为(9.3±7.0)h、(22.5±16.2)h、(21.2±15.3)h和(30.6±19.4)h。M、T1和T2组与C组相比差异有统计学意义(P<0.01);各组间不良反应差异无统计学意义(P>0.05)。结论小儿硬膜外腔注入曲马多2mg/kg和lmg/kg与吗啡0.04mg/kg效果相似,可替带吗啡用于术后镇痛。

Objective To compare the postoperative analgesic effect of different dose tramadol and morphine administrated through epidural space under basic anesthesia with ketaminc in children. Methods Eighty patients undergoing lower abdominal and perineal operation were randomly allocated into 4 groups: control group(C) saline 3ml, morphine group(M) morphine 0.04mg/kg + droperidal 0.03mg/kg, tramadol group 1 (T1) tramadol 1mg/kg + droperidal 0.03 trig/kg, tramadol group 2 (T2) tramadol 2mg/kg + droperidal 0.03mg/kg. All patients received a single injection epidurally before the end of operation. Pain scores and adverse effects were recorded for 48 hours. Duration of excellent analgesia(DEA) was recorded. Results DEA was 9.3±7.0 h in group C, 22.5±16.2 h in group M, 21.2±15.3 h in group T1 and 30.6±19.4 h in group T2. Excellent analgesic duration were significantly longer in group M, T1 and T2 compared with group C (P<0.01). Adverse effects were same in these three groups. Conclusion The analgesic effects with tramadol 2mg/kg and Img/kg epidural injection were the same as with morphine 0.04mg/kg epidural injection, and can replace morphine for postoperative analgesia.