罗哌卡因用于小儿术后镇痛

EPIDURAL ROPIVACAINE FOR POSTOPERATIVE PEDIATRIC ANALGESIA

摘要:

目的:评价0.075％罗哌卡因或布比卡因复合芬太尼对儿童术后镇痛的效果、运动阻滞情况及其不良副反应。方法:选择ASA(Ⅰ～Ⅱ)级择期腹部以下手术的患儿60例。在蛛网膜下腔-硬膜外联合麻醉下进行手术,以0.075％罗哌卡因复合0.0002％芬太尼或0.075％布比卡因复合0.0002％芬太尼进行术后镇痛,5～9岁患儿以3ml·h~(-1),10～14岁以4ml·h~(-1)的速率硬膜外腔持续注入,由双亲或患儿补充镇痛剂量2ml/次,锁定间隔时间为20分钟,观察术后24小时内镇痛效果,以PCA次数衡量镇痛效果:优≤3次,良4～8次,差>8次。观察术后患儿恶心、呕吐、下肢麻木、头痛、皮肤瘙痒、尿潴留等不良反应。结果 术后镇痛效果的优良率罗哌卡因组为97％,布比卡因组为94％,恶心、呕吐、下肢麻木、头痛、皮肤瘙痒、尿潴留发生率两组间无明显差异。罗哌卡因组的运动阻滞较布比卡因组恢复快(P

Abstract:

Objective: To evaluate the analgesic, motor block, and adverse side effects of 0.075% ropiv-acaine or bupivacaine combined with fentanyl in post-operative children. Methods: Sixty children, under combined spinal and epidural block, operated for subabdominal surgery. After operations, they received either 0. 075% ropivacaine or 0. 075% bupivacaine mixed with 0. 0002% fentanyl for postoperative analgesia. Patient-controlled or parent-controlled when necessary, bolus dosage was 2 ml with 20 min lockout time and 3 ml per hour background infusion for the children aged 5 - 9, and of 4 ml per hour for those aged 10-14. Analgesic efficacy within 24 hrs were observed and scaled as excellent analgesia with equal or less than 3 presses, as good with 4-8 presses, and as poor with more than 8 presses. Postoperative nausea, vomiting, headache, pruritus, leg numbness, and urine retention were observed. Results: Cumulative percentage of excellence and good was 97% with ropivacaine, a little higher than 94% with bupivacaine. The occurrence of adverse effects was comparable between the two groups. Motor block with ropivacaine was recorded earlier than that with bupivacaine. Conclusion; Ropivacaine is superior to bupivacaine in postoperative analgesia and in motor recovery and is as safe as bupivacaine.