Abdulatif Mohamed, El-Sanabary Mohga
Department of Anesthesiology, Cairo University, Cairo, Egypt.
Anesth Analg. 2002 Nov;95(5):1215-8, table of contents. doi: 10.1097/00000539-200211000-00018.
In a randomized, double-blinded study, we examined the analgesic efficacy of caudal neostigmine, bupivacaine, or a mixture of both drugs in 60 children. After the induction of general anesthesia, children were allocated randomly into three groups (n = 20) to receive a caudal injection of either 0.25% bupivacaine 1 mL/kg, with or without neostigmine 2 micro g/kg, or neostigmine 2 micro g/kg in normal saline 1 mL/kg. Intraoperatively, children receiving caudal bupivacaine or a bupivacaine/neostigmine mixture maintained hemodynamic stability, required less inhaled anesthetics, and had a shorter recovery time compared with the caudal neostigmine alone. Postoperatively, the caudal bupivacaine/neostigmine mixture resulted in superior analgesia compared with the other two groups. Recovery to first rescue analgesic times were (mean +/- SD) 22.8 +/- 2.9 h, 8.1 +/- 5.9 h, and 5.2 +/- 2.1 h in the bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.001). In addition, the bupivacaine and neostigmine groups received more doses of paracetamol than the bupivacaine/neostigmine group to maintain adequate analgesia in the first 24 postoperative h. Postoperative vomiting occurred in 25%, 10%, and 30% in the caudal bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.01). We conclude that caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery.
Caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. Co-administration of the two drugs is associated with extended postoperative analgesia and reduced need for supplementary analgesics.
在一项随机双盲研究中，我们在60名儿童中研究了尾骶部注射新斯的明、布比卡因或两种药物混合物的镇痛效果。全身麻醉诱导后，儿童被随机分为三组（n = 20），分别接受尾骶部注射0.25%布比卡因1 mL/kg（含或不含新斯的明2 μg/kg），或新斯的明2 μg/kg加生理盐水1 mL/kg。术中，接受尾骶部布比卡因或布比卡因/新斯的明混合物的儿童血流动力学稳定，吸入麻醉药用量较少，与单独尾骶部注射新斯的明相比恢复时间更短。术后，尾骶部布比卡因/新斯的明混合物的镇痛效果优于其他两组。布比卡因/新斯的明组、布比卡因组和新斯的明组首次需要补救性镇痛的时间（均值±标准差）分别为22.8±2.9小时、8.1±5.9小时和5.2±2.1小时（P < 0.001）。此外，为在术后24小时内维持足够的镇痛效果，布比卡因组和新斯的明组使用对乙酰氨基酚的剂量比布比卡因/新斯的明组更多。尾骶部布比卡因/新斯的明组、布比卡因组和新斯的明组术后呕吐发生率分别为25%、10%和30%（P < 0.01）。我们得出结论，在接受尿道下裂修复手术的儿童中，尾骶部注射2 μg/kg新斯的明的术后镇痛效果与尾骶部注射布比卡因相当。
在接受尿道下裂修复手术的儿童中，尾骶部注射2 μg/kg新斯的明的术后镇痛效果与尾骶部注射布比卡因相当。两种药物联合使用可延长术后镇痛时间并减少对补充镇痛药的需求。
