Mahajan Rajesh, Grover Vinod K, Chari Pramila
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, H.No.53, Sector 24-A, Chandigarh-160023, India.
Can J Anaesth. 2004 Aug-Sep;51(7):702-6. doi: 10.1007/BF03018429.
To evaluate the analgesic efficacy and duration of varying doses of caudal neostigmine with plain bupivacaine and its side effects in children undergoing genito-urinary surgery.
In a randomized double-blind prospective study 80 boys aged two to eight years scheduled for surgical repair of hypospadias were allocated randomly to one of four groups (n = 20 each) and received either only caudal 0.25% plain bupivacaine 0.5 mL.kg(-1) (Group I) or 0.25% plain bupivacaine 0.5 mL.kg(-1) with neostigmine (Groups II-IV) in doses of 2, 3 and 4 microg.kg(-1) respectively. Postoperative pain was assessed for 24 hr using an objective pain score. Blood pressure, heart rate, oxygen saturation, total amount of analgesic consumed and adverse effects were also recorded.
The duration of postoperative analgesia in Group I (5.1 +/- 2.3 hr) was significantly shorter than in the other three groups (II -16.6 +/- 4.9 hr; III - 17.2 +/- 5.5 hr; IV - 17.0 +/- 5.8 hr; P < 0.05). Total analgesic (paracetamol) consumption was significantly more in Group I (697.6 +/- 240.7 mg) than in the groups receiving caudal neostigmine (II - 248.0 +/- 178.4; III - 270.2 +/- 180.8 and IV -230.6 +/- 166.9 mg; P < 0.05). Groups II, III and IV were comparable with regards to duration of postoperative analgesia and total analgesic consumption (P > 0.05). Incidence of nausea and vomiting were comparable in all four groups. No significant alteration in vital signs or any other adverse effects were observed.
Caudal neostigmine (2, 3 and 4 microg.kg(-1)) with bupivacaine produces a dose-independent analgesic effect ( approximately 16-17 hr) in children as compared to those receiving caudal bupivacaine alone (approximately five hours) and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.
评估不同剂量的尾椎新斯的明与单纯布比卡因联合使用时的镇痛效果、持续时间及其在接受泌尿生殖系统手术儿童中的副作用。
在一项随机双盲前瞻性研究中，将80名年龄在2至8岁、计划进行尿道下裂手术修复的男孩随机分为四组（每组n = 20），分别接受仅尾椎注射0.25%单纯布比卡因0.5 mL·kg⁻¹（I组），或0.25%单纯布比卡因0.5 mL·kg⁻¹与新斯的明联合使用（II - IV组），新斯的明剂量分别为2、3和4 μg·kg⁻¹。使用客观疼痛评分评估术后24小时的疼痛情况。还记录了血压、心率、血氧饱和度、镇痛药物总消耗量及不良反应。
I组术后镇痛持续时间（5.1 ± 2.3小时）明显短于其他三组（II组 - 16.6 ± 4.9小时；III组 - 17.2 ± 5.5小时；IV组 - 17.0 ± 5.8小时；P < 0.05）。I组的镇痛药物（对乙酰氨基酚）总消耗量（697.6 ± 240.7毫克）明显多于接受尾椎新斯的明的组（II组 - 248.0 ± 178.4；III组 - 270.2 ± 180.8；IV组 - 230.6 ± 166.9毫克；P < 0.05）。II、III和IV组在术后镇痛持续时间和镇痛药物总消耗量方面具有可比性（P > 0.05）。四组中恶心和呕吐的发生率相当。未观察到生命体征有明显改变或任何其他不良反应。
与仅接受尾椎布比卡因的儿童（约5小时）相比，尾椎新斯的明（2、3和4 μg·kg⁻¹）与布比卡因联合使用时，在儿童中产生剂量无关的镇痛效果（约16 - 17小时），并减少了术后补救性镇痛药物的消耗量，且未增加不良反应的发生率。
