Carr A S, Fear D W, Sikich N, Bissonnette B
Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
Can J Anaesth. 1998 Nov;45(11):1054-60. doi: 10.1007/BF03012391.
Epidural infusions of fentanyl (2 micrograms.ml-1) alone or combined with bupivacaine 0.125% were compared for perioperative analgesia, motor block and other side-effects in children who underwent urological surgery.
In a prospective, double-blind study, 42 children, ASA I-II, 1-16 yr, were randomly allocated to receive either epidural F (fentanyl bolus 2 micrograms.kg-1 in 0.5 ml.kg-1 saline followed by 2 micrograms.ml-1 fentanyl infusion) or epidural F-B (fentanyl bolus 2 micrograms.kg-1 in 0.5 ml.kg-1 bupivacaine 0.25% followed by 2 micrograms.ml-1 fentanyl infusion in bupivacaine 0.125%) after induction of general anaesthesia. Adequacy of analgesia, lower limb motor block and side-effects were assessed four hourly postoperatively.
Both infusion regimens provided excellent analgesia (median objective pain scores = 0). Epidural infusion rates were similar in the F (0.29 +/- 0.07 ml.kg-1.hr-1) and F-B (0.26 +/- 0.05 ml.kg-1.hr-1) groups. Three children in the F group and all children in the F-B group developed lower limb weakness. (P < 0.05) Bromage scores were different in the F group (median 0, range 0-0.66) compared with the F-B group (median 0.33, range 0-1) (P < 0.001). Other side-effects did not differ.
Postoperative epidural fentanyl infusion provides equipotent analgesia to administration of a solution including both fentanyl and bupivacaine 0.125% and causes less lower limb weakness. No reduction in the fentanyl requirement resulted from the addition of bupivacaine 0.125%.
比较单独硬膜外输注芬太尼（2微克·毫升⁻¹）或与0.125%布比卡因联合使用时，对接受泌尿外科手术儿童的围手术期镇痛、运动阻滞及其他副作用的影响。
在一项前瞻性双盲研究中，将42例年龄1 - 16岁、ASA I-II级的儿童随机分为两组，在全身麻醉诱导后，一组接受硬膜外F方案（2微克·千克⁻¹芬太尼推注于0.5毫升·千克⁻¹生理盐水中，随后以2微克·毫升⁻¹芬太尼输注），另一组接受硬膜外F-B方案（2微克·千克⁻¹芬太尼推注于0.5毫升·千克⁻¹ 0.25%布比卡因中，随后以2微克·毫升⁻¹芬太尼在0.125%布比卡因中输注）。术后每4小时评估镇痛效果、下肢运动阻滞及副作用。
两种输注方案均提供了良好的镇痛效果（中位客观疼痛评分 = 0）。F组（0.29 ± 0.07毫升·千克⁻¹·小时⁻¹）和F-B组（0.26 ± 0.05毫升·千克⁻¹·小时⁻¹）的硬膜外输注速率相似。F组有3名儿童和F-B组所有儿童出现下肢无力。（P < 0.05）F组的 Bromage评分（中位值0，范围0 - 0.66）与F-B组（中位值0.33，范围0 - 1）不同（P < 0.001）。其他副作用无差异。
术后硬膜外输注芬太尼与输注含芬太尼和0.125%布比卡因的溶液提供的镇痛效果相当，且引起的下肢无力较少。添加0.125%布比卡因并未减少芬太尼的需求量。
