CAJ | 학술논문

目的观察罗哌卡因复合曲马多骶管阻滞与单独应用罗哌卡因、曲马多,对小儿尿道下裂成形术后镇痛时间、疼痛评分、镇痛次数、睡眠质量满意度和并发症的影响.探讨罗哌卡因复合曲马多和单独应用曲马多、罗哌卡因能否提供满意的术后镇痛. 方法选取自2012年6月～2013年2月于我院行尿道下裂成形术的患儿66名,美国麻醉医师协会(ASA)分级Ⅰ级,年龄1岁～6岁,采用完全随机设计的方法分为3组(每组22例):0.2％罗哌卡因1 ml/kg组(L组)、0.2％罗哌卡因1 ml/kg+曲马多1.5 mg/kg组(LT组)、0.9％氯化钠1 ml/kg+曲马多1.5 mg/kg组(T组).麻醉维持均采用骶管阻滞复合全凭七氟醚吸入全麻.观察并记录镇痛维持时间(骶管阻滞到术后第1次镇痛给药的时间),术毕患儿清醒1、2、4、6、12、24 h三点疼痛评分,术后24 h镇痛次数,睡眠质量满意度评估,并发症等. 结果镇痛时间比较,LT组(14.5±2.5)h比其他两组明显延长(P＜0.05).3组疼痛评分在2h前差异无统计学意义,2h到6hT组与L组、LT组比较,差异有统计学意义(P＜0.05).T组与LT组、L组比较,术后24 h所需镇痛次数明显加(P＜0.05).术后寒战发生率L组为18％,而LT组、T组为0.3组患儿术毕清醒均未出现运动神经阻滞,呕吐次数也无明显增加.LT组100％的患儿父母对患儿术后24 h睡眠质量满意度为优和良. 结论 0.2％罗哌卡因1 ml/kg复合曲马多1.5 mg/kg骶管阻滞用于6岁以下小儿尿道下裂成形术后镇痛是安全、有效的,可有效镇痛(14.5±2.5)h,并发症少且能有效减少术后寒战的发生.
목적 관찰라고잡인복합곡마다저관조체여단독응용라고잡인、곡마다,대소인뇨도하렬성형술후진통시간、동통평분、진통차수、수면질량만의도화병발증적영향.탐토라고잡인복합곡마다화단독응용곡마다、라고잡인능부제공만의적술후진통. 방법 선취자2012년6월～2013년2월우아원행뇨도하렬성형술적환인66명,미국마취의사협회(ASA)분급Ⅰ급,년령1세～6세,채용완전수궤설계적방법분위3조(매조22례):0.2％라고잡인1 ml/kg조(L조)、0.2％라고잡인1 ml/kg+곡마다1.5 mg/kg조(LT조)、0.9％록화납1 ml/kg+곡마다1.5 mg/kg조(T조).마취유지균채용저관조체복합전빙칠불미흡입전마.관찰병기록진통유지시간(저관조체도술후제1차진통급약적시간),술필환인청성1、2、4、6、12、24 h삼점동통평분,술후24 h진통차수,수면질량만의도평고,병발증등. 결과 진통시간비교,LT조(14.5±2.5)h비기타량조명현연장(P＜0.05).3조동통평분재2h전차이무통계학의의,2h도6hT조여L조、LT조비교,차이유통계학의의(P＜0.05).T조여LT조、L조비교,술후24 h소수진통차수명현가(P＜0.05).술후한전발생솔L조위18％,이LT조、T조위0.3조환인술필청성균미출현운동신경조체,구토차수야무명현증가.LT조100％적환인부모대환인술후24 h수면질량만의도위우화량. 결론 0.2％라고잡인1 ml/kg복합곡마다1.5 mg/kg저관조체용우6세이하소인뇨도하렬성형술후진통시안전、유효적,가유효진통(14.5±2.5)h,병발증소차능유효감소술후한전적발생.
Objective The aim of this study was to determine whether the caudal block with tramadol and ropivacaine combination provides better analgesia in respect of analgesia time,pain scores,total analgesic doses and side effects,compared with ropivacaine or tramadol alone.Methods Sixty-six ASA Ⅰ boys,aged 1 y-6 y old,underwent hypospadias surgery in our hospital from June of 2012 to February of 2013 were involved in this study.The boys were allocated randomly to three groups.Children in group L received 0.2％ ropivacaine 1 ml/kg,group LT received an identical local anesthetic dose mixed with tramadol 1.5 mg/kg and 0.2％ropivacaine 1 ml/kg,and group T received caudal tramadol 1.5 mg/kg in 0.9％ sodium chloride in the same total volume (1 ml/kg).General anesthesia were induced and maintained with sevofurane.Duration of analgesia (time between caudal injection and first administration of analgesic) and requirement of additional analgesics were noted.Pain assessments were made 1,2,4,6,12 h and 24 h after recovery from anesthesia with reference to a three-point scale.Complications and parents' satisfaction with the procedure were recorded.Results Analgesia time (time between caudal injection and first administration of analgesic) in group LT (14.5±2.5) h was signicantly longer than in the other two groups (P＜0.05).Pain scores were similar in the three groups in the first two hours,and was signicantly higher in group T than groups L and LT both at 2,4 h and 6 h after operation (P＜0.05).In group T,more patients required additional analgesia after surgery than in the other two groups (P＜0.05).Only patients in group L (18％) shivered after operation.No signs of motor block were observed after the first postoperative hour in any of the patients.The incidence of emesis was not statistically different between groups.Furthermore,100％ parents in group LT were evaluated with excellent and good sleep quality.Conclusions Caudal block with 0.2％ ropivacaine (1 ml/kg) and tramadol (1.5 mg/kg) combinationis safe and effective for postoperative analgesia in pediatric hypospadias surgery,and it can significantly reduce the incidence of postoperative shivering.