Baris Sibel, Karakaya Deniz, Kelsaka Ebru, Güldogus Fuat, Ariturk Ender, Tür Ayla
Departments of Anaesthesiology and Paediatric Surgery, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, Turkey.
Paediatr Anaesth. 2003 Feb;13(2):126-31. doi: 10.1046/j.1460-9592.2003.00979.x.
The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy.
Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated.
The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups.
Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.
本研究旨在评估0.75 ml.kg-1 0.25%布比卡因添加芬太尼或咪达唑仑用于小儿腹股沟疝修补术骶管阻滞的强度和效果。
75例患儿随机分为三组，麻醉诱导后分别接受含1 μg.kg(-1)芬太尼的0.25%布比卡因（BF组）、含50 μg.kg(-1)咪达唑仑的0.25%布比卡因（BM组）或单纯布比卡因（B组）的骶管阻滞。评估血流动力学参数、疼痛程度、额外镇痛需求和副作用。
与BF组和BM组相比，B组骶管阻滞后10、20、30分钟时的平均收缩动脉压更高。BF组术中平均心率低于其他组。BF组所有患者（100%）、BM组23例患者（92%）和B组21例患者（84%）获得了充分镇痛（P>0.05）。B组恢复至Aldrete评分为10分的时间明显短于BM组（P<0.05）。虽然差异不显著，但B组也短于BF组。各组在术后24小时内的额外镇痛需求无差异。咪达唑仑组术后60和90分钟时的镇静评分高于其他组。
对于接受单侧腹股沟疝修补术的小儿，麻醉诱导后立即给予0.75 ml.kg(-1) 0.25%布比卡因与50 μg.kg(-1)咪达唑仑或1 μg.kg(-1)芬太尼进行骶管阻滞，并不比单纯布比卡因具有更多的镇痛优势。
