Goodarzi M
Department of Anesthesia, Children's Hospital Los Angeles, California 90027, USA.
Paediatr Anaesth. 1999;9(5):419-22. doi: 10.1046/j.1460-9592.1999.00370.x.
The safety and side-effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30-h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side-effects, is preferable to morphine and fentanyl for epidural analgesia in children.
在90例接受骨科手术的儿童中，比较了硬膜外给予亲水性（吗啡）、高度亲脂性（芬太尼）以及具有中等亲水和亲脂活性的药物（氢吗啡酮）的安全性和副作用情况。90例患者被随机分配（每组30例）接受硬膜外吗啡、氢吗啡酮或芬太尼用于术后镇痛。在术后30小时内评估并比较呼吸效应、恶心、嗜睡、尿潴留、瘙痒和视觉疼痛量表。在吗啡组中，25%出现氧饱和度低于90%的呼吸抑制，但芬太尼组或氢吗啡酮组未发生呼吸抑制。嗜睡在所有组的一些患者中都很突出，但在吗啡组持续时间更长。统计学上，各组之间恶心无显著差异，但瘙痒在吗啡组更严重且更频繁。与芬太尼组和氢吗啡酮组相比，吗啡组尿潴留的发生率更高。总之，硬膜外氢吗啡酮副作用较少，在儿童硬膜外镇痛中比吗啡和芬太尼更可取。
