Mahajan R, Batra Y K, Grover V K, Kajal J
Department of Anesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Int J Clin Pharmacol Ther. 2001 Mar;39(3):116-20. doi: 10.5414/cpp39116.
This study was designed to evaluate the analgesic efficacy of caudal midazolam-bupivacaine combination in providing post-operative pain relief in children undergoing genitourinary surgery and to study the occurrence of adverse effects.
Thirty children, aged 2 to 8 years, scheduled for genitourinary surgery were allocated randomly to receive either 0.25% bupivacaine 0.5 ml/kg (group B; n = 15) or 0.25% bupivacaine 0.5 ml/kg with 50 microg/kg midazolam (group BM; n = 15) by the caudal route immediately after induction of general anesthesia. Heart rate, arterial blood pressure and oxygen saturation were monitored throughout the study period. Postoperative pain was assessed at regular intervals for 12 hours using an objective pain score. Analgesia was supplemented whenever the pain score was > or = 4. Duration of analgesia, as well as the requirement of additional analgesics, were noted.
Lowest pain scores were observed with the addition of midazolam to caudal bupivacaine (p < 0.01). Duration of analgesia was longer in group BM (11 +/- 0.5 h) as compared to group B (7.4 +/- 2.1 hours) (p < 0.05). Fewer children (26.6%) required additional analgesia in the combination group whereas in group B, 60% of the children received analgesic supplements within 6 hours after surgery (p < 0.05). There were no significant changes in heart rate, blood pressure and oxygen saturation in both groups. We observed no untoward event in either of the groups.
Caudal administration of bupivacaine-midazolam mixture prolongs post-operative analgesia compared to bupivacaine alone without causing any adverse effects.
本研究旨在评估骶管注射咪达唑仑-布比卡因合剂在小儿泌尿外科手术术后镇痛中的效果，并研究不良反应的发生情况。
30例年龄在2至8岁、计划行泌尿外科手术的患儿，在全身麻醉诱导后立即通过骶管途径随机分为两组，分别接受0.25%布比卡因0.5 ml/kg（B组；n = 15）或0.25%布比卡因0.5 ml/kg加50 μg/kg咪达唑仑（BM组；n = 15）。在整个研究期间监测心率、动脉血压和血氧饱和度。术后每隔一定时间使用客观疼痛评分法评估12小时的疼痛情况。当疼痛评分≥4分时补充镇痛药物。记录镇痛持续时间以及额外镇痛药物的需求情况。
骶管布比卡因中加入咪达唑仑后疼痛评分最低（p < 0.01）。BM组的镇痛持续时间（11 ± 0.5小时）比B组（7.4 ± 2.1小时）长（p < 0.05）。联合组中需要额外镇痛的患儿较少（26.6%），而B组中60%的患儿在术后6小时内接受了镇痛补充（p < 0.05）。两组的心率、血压和血氧饱和度均无显著变化。两组均未观察到不良事件。
与单独使用布比卡因相比，骶管注射布比卡因-咪达唑仑合剂可延长术后镇痛时间且不引起任何不良反应。
