Kokki Hannu, Laisalmi Merja, Vanamo Kari
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland.
J Opioid Manag. 2006 Sep-Oct;2(5):290-4. doi: 10.5055/jom.2006.0043.
The results of studies exploring the efficacy of interpleural analgesia in children post-thoracotomy have frequently been inconclusive. In this pilot study, we have evaluated the efficacy and safety of interpleural bupivacaine and intravenous (IV) oxycodone in pain treatment after thoracotomy in 10 generally healthy children, aged 10 months to 12 years, with patent ductus arteriosus who underwent thoracotomy.
After surgery, all 10 children were given ibuprofen 10 mg/kg rectally every six hours. The first dose of interpleural bupivacaine (2 mg/kg) was given with epinephrine at the end of surgery, and thereafter plain bupivacaine (1 mg/kg) was given every two hours if the pain score was 4 or higher on an 11-point numeric rating scale (0 = no pain, 10 = worst possible pain). For rescue analgesia, children were provided oxycodone 0.1 mg/kg IV if pain was not relieved sufficiently with ibuprofen and bupivacaine. Vital signs, pain scores, and all adverse effects were monitored continuously for 24 hours.
All 10 children needed both interpleural bupivacaine and IV oxycodone. The number of bupivacaine doses ranged between three and 10 (mean = 6.1, SD = 2.3), and the number of oxycodone doses ranged between one and 12 (mean = 6.0, SD = 3.6). No cases of low respiratory rate or low peripheral oxygen saturation or any serious adverse events were recorded.
Scheduled nonopioid analgesic (ibuprofen) with interpleural bupivacaine did not provide sufficient analgesia for post-thoracotomy pain in young children. IV oxycodone was found to be an effective and safe opioid supplement to the pain regimen.
探索小儿开胸术后胸膜间镇痛效果的研究结果常常尚无定论。在这项初步研究中，我们评估了胸膜间注射布比卡因和静脉注射羟考酮对10名年龄在10个月至12岁、患有动脉导管未闭且接受开胸手术的一般健康儿童开胸术后疼痛治疗的有效性和安全性。
术后，所有10名儿童每6小时经直肠给予10 mg/kg布洛芬。在手术结束时给予首剂胸膜间注射布比卡因（2 mg/kg）加肾上腺素，此后如果在11分数字评分量表（0 = 无疼痛，10 = 最严重疼痛）上疼痛评分达到4或更高，则每2小时给予普通布比卡因（1 mg/kg）。对于补救镇痛，如果布洛芬和布比卡因不能充分缓解疼痛，则给予儿童0.1 mg/kg静脉注射羟考酮。连续24小时监测生命体征、疼痛评分和所有不良反应。
所有10名儿童均需要胸膜间注射布比卡因和静脉注射羟考酮。布比卡因剂量在3至10剂之间（平均 = 6.1，标准差 = 2.3），羟考酮剂量在1至12剂之间（平均 = 6.0，标准差 = 3.6）。未记录到低呼吸频率或低外周血氧饱和度的病例或任何严重不良事件。
计划性非阿片类镇痛药（布洛芬）联合胸膜间注射布比卡因对幼儿开胸术后疼痛的镇痛效果不足。静脉注射羟考酮被发现是疼痛治疗方案中一种有效且安全的阿片类补充药物。
