Güneş Yasemin, Gündüz Murat, Unlügenç Hakki, Ozalevli Mehmet, Ozcengiz Dilek
Department of Anaesthesiology, Faculty of Medicine, Cukurova University, Balcali Adana, Turkey.
Paediatr Anaesth. 2004 Apr;14(4):324-8. doi: 10.1046/j.1460-9592.2003.01214.x.
In this study we compared caudal with intravenous (i.v.) tramadol given pre- or postoperatively for pain relief in boys having hypospadias repair.
The study was approved by the Ethics Committee and informed written consent was obtained from the parents of each patient. Patients (n = 134), aged 1-3 years, American Society of Anesthesiologists (ASA) physical status I, scheduled for hypospadias surgery were recruited. The patients were randomly allocated to one of the four groups: group I (n = 33), received 2 mg.kg(-1) (0.5 ml.kg(-1)) of caudal tramadol after the surgical procedure was completed, group II (n = 33) received 2 mg.kg(-1) (0.5 ml.kg(-1)) of caudal tramadol before incision, group III (n = 34) received 2 mg.kg(-1) tramadol intravenously, after surgery and group IV (n = 34) received 2 mg.kg(-1) tramadol intravenously, after anaesthesia induction. When the patients were fully awake in the recovery area, heart rate, arterial pressure, peripheral oxygen saturation, respiratory rate, pain and sedation scores were recorded at 5, 10, 15, 30, 60 min, and 2, 3, 4, 6, 12 and 24 h postoperatively and side-effects were noted. Pain was assessed using an objective pain score (OPS).
The OPS were lower in caudal tramadol groups than in i.v. tramadol groups only at 3 h (P < 0.05). The duration of postoperative analgesia was longer in the caudal groups than in the i.v. groups (P = 0.001). However, the duration of postoperative analgesia was unaffected by the timing of administration.
Caudal tramadol provides better and longer lasting postoperative analgesia than i.v. tramadol. These results also suggest that preoperative caudal tramadol did not provide any clinically perceptible benefits compared with postoperative caudal tramadol.
在本研究中，我们比较了在患有尿道下裂修复术的男孩术前或术后给予尾侧注射与静脉注射曲马多进行疼痛缓解的效果。
本研究经伦理委员会批准，并获得每位患者家长的书面知情同意。招募了年龄在1至3岁、美国麻醉医师协会（ASA）身体状况为I级、计划进行尿道下裂手术的患者（n = 134）。患者被随机分配到四组中的一组：第一组（n = 33），在手术完成后接受2 mg·kg⁻¹（0.5 ml·kg⁻¹）的尾侧曲马多；第二组（n = 33）在切口前接受2 mg·kg⁻¹（0.5 ml·kg⁻¹）的尾侧曲马多；第三组（n = 34）在术后静脉注射2 mg·kg⁻¹曲马多；第四组（n = 34）在麻醉诱导后静脉注射2 mg·kg⁻¹曲马多。当患者在恢复区完全清醒时，在术后5、10、15、30、60分钟以及2、3、4、6、12和24小时记录心率、动脉压、外周血氧饱和度、呼吸频率、疼痛和镇静评分，并记录副作用。使用客观疼痛评分（OPS）评估疼痛。
仅在术后3小时，尾侧曲马多组的OPS低于静脉注射曲马多组（P < 0.05）。尾侧给药组的术后镇痛持续时间比静脉注射组更长（P = 0.001）。然而，术后镇痛持续时间不受给药时间的影响。
尾侧注射曲马多比静脉注射曲马多提供更好且更持久的术后镇痛效果。这些结果还表明，与术后尾侧注射曲马多相比，术前尾侧注射曲马多没有提供任何临床上可察觉的益处。
