Khalil Samia N, Farag Adel, Hanna Ehab, Govindaraj Ranganathan, Chuang Alice Z
Department of Anesthesiology, The University of Texas Medical School at Houston, Texas, USA.
Middle East J Anaesthesiol. 2005 Feb;18(1):123-32.
The anesthesia literature cites a high incidence of postoperative vomiting (POV) after pediatric ochidopexy and hernia repair (34-50%) and after penile procedures (37-49%). We hypothesized that regional analgesia combined with avoidance of narcotics administered to children scheduled for lower abdominal or urologic procedures may be associated with a lower incidence of POV. The aim of this prospective study was to 1) assess the incidence of POV in children in the hospital and during a 24-h post-anesthesia study period, and 2) evaluate the effect of age on POV.
After obtaining institutional and parental consent, 110 pediatric outpatients, 1-12 yr old, ASA physical status I or II, scheduled for elective outpatient urologic or lower abdominal procedures, were enrolled. Children were fasting and premedicated with midazolam, 0.5 mg/kg p.o. They received a combined light general anesthesia and a presurgical caudal block. Anesthesia was induced via a mask and consisted of halothane and nitrous oxide in oxygen. For the caudal block 1 ml/kg of 0.25% bupivacaine or 0.2% ropivacaine were used to provide intra- and postoperative pain relief. No prophylactic antiemetics were administered.
All caudal blocks provided adequate intraoperative pain relief. The incidence of POV was low, 12% at the hospital, 13% for the 24-h study period, and was not affected by age.
We concluded that regional analgesia combined with the avoidance of narcotics administered to children scheduled for elective urologic or lower abdominal procedures, is associated with a lower incidence of POV and that age did not affect the incidence of POV.
麻醉学文献记载，小儿睾丸固定术和疝气修补术后（34%-50%）以及阴茎手术后（37%-49%），术后呕吐（POV）的发生率很高。我们推测，对于计划接受下腹部或泌尿外科手术的儿童，区域镇痛联合避免使用麻醉性镇痛药可能与较低的POV发生率相关。这项前瞻性研究的目的是：1）评估住院期间及麻醉后24小时研究期内儿童POV的发生率；2）评估年龄对POV的影响。
在获得机构和家长同意后，纳入110例1-12岁、ASA身体状况为I或II级、计划接受择期门诊泌尿外科或下腹部手术的儿科门诊患者。患儿禁食，并口服咪达唑仑进行术前用药，剂量为0.5mg/kg。他们接受了浅全身麻醉联合术前骶管阻滞。通过面罩诱导麻醉，麻醉药物包括氟烷和氧气中的氧化亚氮。骶管阻滞使用1ml/kg的0.25%布比卡因或0.2%罗哌卡因，以提供术中及术后的疼痛缓解。未给予预防性止吐药。
所有骶管阻滞均提供了足够的术中疼痛缓解。POV的发生率较低，住院期间为12%，24小时研究期内为13%，且不受年龄影响。
我们得出结论，对于计划接受择期泌尿外科或下腹部手术的儿童，区域镇痛联合避免使用麻醉性镇痛药与较低的POV发生率相关，且年龄不影响POV的发生率。
