小儿骶管复合用药对术后镇痛的影响

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

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(P<0.01)。但Ⅳ组术后恶心呕吐的发生率高于其他三组(P<0.05)。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。

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 b after surgery. The duration of caudal analgesia, fentanyl requirements, side effects, and discharge time were recorded. Results Duration of caudal analgesia in group Ⅳ was （510.7±64.9） min, which was longer than （174.5±39.3） rain in roupⅠ, （291.7±50.8） min in group Ⅱ, or （242.0± 62.8） rain in group Ⅲ. The incidence of postoperative nausea and vomiting was more frequent 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.