氯胺酮静脉或骶管给药复合罗哌卡因骶管阻滞麻醉的镇痛效果研究

Study on analgesic effect of intravenous or caudal administration of ketamine combined with ropivacaine caudal block anasthesia

目的 探讨氯胺酮静脉或骶管给药复合罗哌卡因骶管阻滞麻醉对择期行鞘膜积液或腹股沟疝修补术患儿的镇痛效果。方法 105例择期行鞘膜积液或腹股沟疝修补术患儿,随机分为对照组(35例)、Kca组(33例)及Kiv组(37例)。对照组实施骶管注射罗哌卡因进行麻醉, Kca组实施骶管注射罗哌卡因和氯胺酮进行麻醉, Kiv组实施骶管注射罗哌卡因和静脉注射氯胺酮进行麻醉。比较三组患儿罗哌卡因半数有效浓度(EC50)、用药情况、不良反应发生情况及术后镇痛持续时间。结果 三组患儿的丙泊酚用量、额外服用氯胺酮占比、额外的氯胺酮用量及术后恶心呕吐(PONV)发生率比较,差异无统计学意义(P>0.05)。对照组、Kca组和Kiv组用序贯法得到的罗哌卡因EC50分别为(0.123±0.024)%、(0.119±0.022)%、(0.092±0.028)%。Kiv组的罗哌卡因EC50低于对照组,差异有统计学意义[95%CI=(0.011, 0.052), P=0.001<0.05];Kiv组的罗哌卡因EC50低于Kca组,差异有统计学意义[95%CI=(0.006, 0.047), P=0.007<0.05];Kca组与对照组的罗哌卡因EC50比较,差异无统计学意义[95%CI=(-0.016, 0.025), P=0.934>0.05]。用Kaplan-Meier生存曲线描记术后镇痛持续时间,对照组、Kca组和Kiv组术后镇痛持续时间分别为276、568、295 min。Kca组的术后镇痛持续时间长于对照组,差异有统计学意义[95%CI=(261, 324), P=0.000<0.05];Kca组的术后镇痛持续时间长于Kiv组,差异有统计学意义[95%CI=(241, 305), P=0.000<0.05];对照组与Kiv组的术后镇痛持续时间比较,差异无统计学意义[95%CI=(-52, 13), P=0.377>0.05]。结论 静脉注射氯胺酮的术中镇痛效果显著,但罗哌卡因骶管阻滞不能增强患儿的术后镇痛效果,然而相同剂量的骶管注射氯胺酮术后镇痛效果良好,但不能改善术中镇痛。

Objective To investigate the analgesic effects of ketamine intravenous or caudal administration of ketamine combined with ropivacaine caudal block anasthesia on children with elective surgery for hydrocele or inguinal hernia. Methods 105 children undergoing elective surgery for hydrocele or inguinal hernia were randomly divided into a control group(35 cases), Kca group(33 cases) and Kiv group(37 cases).Children of the control group received caudal injection of ropivacaine for anesthesia;children of the Kca group received caudal injection of ropivacaine and ketamine for anesthesia;children of the Kiv group received caudal injection of ropivacaine and intravenous injection of ketamine for anesthesia. Median effective concentration(EC50)of ropivacaine, medication, incidence of adverse reactions and postoperative analgesia duration were compared between the three groups. Results The differences in the dosage of propofol, the proportion of extra dosage of ketamine, the extra dosage of ketamine and the incidence of postoperative nausea and vomiting(PONV) were not statistically significant(P>0.05). The EC50 of ropivacaine obtained by sequential method was(0.123±0.024)%of the control group,(0.119±0.022)% of the Kca group and(0.092±0.028)% of the Kiv group. The EC50 of ropivacaine of the Kiv group was lower than that of the control group, and the difference was statistically significant [95%CI=(0.011, 0.052), P=0.001<0.05]. The EC50 of ropivacaine of the Kiv group was lower than that of the Kca group, and the difference was statistically significant [95%CI=(0.006, 0.047), P=0.007<0.05]. The difference in EC50 of ropivacaine between the Kiv group was not statistically significant [95%CI=(0.016, 0.025),P=0.934>0.05]. The duration of postoperative analgesia was described with Kaplan-Meier survival curve. The duration of postoperative analgesia was 276 min of the control group, 568 min of the Kca group and 295 min of the Kiv group. The duration of postoperative analgesia of the Kca group was longer than that of the control group,and the difference was statistically significant [95%CI=(261, 324), P=0.000<0.05]. The duration of postoperative analgesia of the Kca group was longer than that of the Kiv group, and the difference was statistically significant [95%CI=(241, 305), P=0.000<0.05]. The difference in the duration of postoperative analgesia between the control group and the Kiv group was not statistically significant [95%CI=(-52, 13), P=0.377>0.05]. Conclusion The intravenous administration of ketamine has good analgesic effect during the surgery, but it cannot enhance the postoperative analgesia of caudal block anasthesia with ropivacaine in children, while caudal administration of identical dose of ketamine has good postoperative analgesia, but it cannot improve analgesia during the surgery.