Prakash S, Tyagi R, Gogia A R, Singh R, Prakash S
Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital New Delhi, India.
Br J Anaesth. 2006 Sep;97(3):385-8. doi: 10.1093/bja/ael155. Epub 2006 Jun 23.
This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children.
Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg(-1) (Group B; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1 mg kg(-1) (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1.5 mg kg(-1) (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 2 mg kg(-1) (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >or=4. Duration of analgesia and requirement for additional analgesics was noted.
Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed.
Caudal tramadol 2 mg kg(-1), combined with bupivacaine 0.25% 0.75 ml kg(-1), provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg(-1) or 1.5 mg kg(-1) in children undergoing inguinal herniotomy.
本研究旨在评估三种剂量的曲马多与布比卡因经尾侧给药用于小儿术后镇痛的效果。
80例年龄在2至8岁行腹股沟疝修补术的患儿，在全身麻醉诱导后立即经尾侧随机分配接受0.25%布比卡因0.75 ml/kg（B组；n = 20）、0.25%布比卡因0.75 ml/kg加1 mg/kg曲马多（BT1组；n = 20）、0.25%布比卡因0.75 ml/kg加1.5 mg/kg曲马多（BT1.5组；n = 20）或0.25%布比卡因0.75 ml/kg加2 mg/kg曲马多（BT2组；n = 20）。监测心率、动脉压和血氧饱和度。术后24小时定期使用全印度医学科学研究所疼痛评分评估疼痛情况。当疼痛评分≥4分时补充镇痛。记录镇痛持续时间和额外镇痛药物的需求。
与B组[4（1）小时]、BT1组[8（0.9）小时]或BT1.5组[11（1）小时]相比，BT2组的镇痛持续时间更长[（均值（标准差）12（0.9）小时]；所有P<0.001。与其他组相比，BT2组的急救镇痛药总消耗量显著更低（P<0.001）。各组之间心率、动脉压和血氧饱和度无显著变化。未观察到不良反应。
对于行腹股沟疝修补术的小儿，与1 mg/kg或1.5 mg/kg曲马多相比，2 mg/kg曲马多经尾侧联合0.25%布比卡因0.75 ml/kg可提供更长的术后镇痛时间，并减少急救镇痛药的需求。
