Gunter J B, McAuliffe J, Gregg T, Weidner N, Varughese A M, Sweeney D M
Department of Anesthesiology, University of Cincinnati, Cincinnati, Ohio, USA.
Paediatr Anaesth. 2000;10(2):167-72. doi: 10.1046/j.1460-9592.2000.00447.x.
We examined the efficacy of epidural butorphanol to either prevent or relieve pruritus associated with epidural morphine infusion in children. Forty-six children were randomized to receive either epidural morphine (M) or epidural M with butorphanol (B) for postoperative analgesia. They received bupivacaine and either M 50 microg.kg-1 or the same dose of M plus B 10 microg.kg-1. Following surgery, a continuous infusion of 0.1% bupivacaine with either M 20 microg.ml-1 or M 20 microg.ml-1 + B 4 microg.ml-1 was given at a rate of 0.3 ml.kg-1.h-1. Pain scores and pruritus scores were recorded every 4 h during epidural infusion. Subjects with a pruritus score=2 received diphenhydramine 0.5 mg.kg-1 i.v. and were switched to an alternate epidural infusion; subjects receiving M (group M) were switched to M+B while subjects receiving M+B (group B) were switched to hydromorphone (H) 4 microg.ml-1. There was no difference in the initial incidence of pruritus (group M 11/18; group B 13/28). No subject in group M required a second change of epidural infusion because of continued pruritus after being switched to M+B; five of 13 subjects in group B continued to experience pruritus after being switched to H and required a second change of epidural infusion or an alternate analgesic modality (P=0.038). The median pruritus score in the first 24 h after changing epidural infusions was 0 in subjects in group MDelta (changed from M to M+B) and 1 in subjects in group BDelta (changed from M+B to H; P=0.012). While the median sedation score in the first 24 h was 1 in both groups, there was a greater incidence of sedation scores of 2 in group B than group M (28% vs 12.3%; P=0.021). B 10 microg.kg-1 was not effective in preventing pruritus associated with bolus epidural administration of M 50 microg.kg-1 in children. B 1.2 microg.kg-1. h-1 was effective in relieving pruritus associated with continuous epidural infusion of M 6 microg.kg-1.h-1.
我们研究了硬膜外注射布托啡诺预防或缓解儿童硬膜外注射吗啡所致瘙痒的疗效。46例儿童被随机分为两组，分别接受硬膜外吗啡（M组）或硬膜外吗啡联合布托啡诺（B组）用于术后镇痛。他们均接受了布比卡因，M组给予50μg·kg-1吗啡，B组给予相同剂量吗啡加10μg·kg-1布托啡诺。术后，以0.3ml·kg-1·h-1的速率持续输注含20μg/ml吗啡的0.1%布比卡因溶液，M组如此，B组则为含20μg/ml吗啡加4μg/ml布托啡诺的溶液。硬膜外输注期间，每4小时记录疼痛评分和瘙痒评分。瘙痒评分为2分的受试者静脉注射0.5mg·kg-1苯海拉明，并更换为另一种硬膜外输注方案；M组（M组）受试者更换为M+B方案，而接受M+B方案的B组受试者更换为4μg/ml氢吗啡酮（H）方案。瘙痒的初始发生率无差异（M组11/18；B组13/28）。M组中没有受试者因更换为M+B方案后仍持续瘙痒而需要再次更换硬膜外输注方案；B组13名受试者中有5名在更换为H方案后仍持续瘙痒，需要再次更换硬膜外输注方案或采用其他镇痛方式（P = 0.038）。更换硬膜外输注方案后的前24小时内，M组（从M更换为M+B）受试者的瘙痒评分中位数为0，B组（从M+B更换为H）受试者的瘙痒评分中位数为1（P = 0.012）。虽然两组前24小时内的镇静评分中位数均为1，但B组镇静评分为2分的发生率高于M组（28%对12.3%；P = 0.021）。10μg·kg-1布托啡诺在预防儿童硬膜外注射50μg·kg-1吗啡所致瘙痒方面无效。1.2μg·kg-1·h-1布托啡诺在缓解硬膜外持续输注6μg·kg-1·h-1吗啡所致瘙痒方面有效。
