Tubbs R Shane, Law Charles, Davis Drew, Shoja Mohammadali M, Acakpo-Satchivi Leslie, Wellons John C, Blount Jeffrey P, Oakes W Jerry
Section of Pediatric Neurosurgery, Department of Pediatrics, University of Alabama at Birmingham and Children's Hospital, Birmingham, Alabama 35233, USA.
J Neurosurg. 2007 Jun;106(6 Suppl):439-40. doi: 10.3171/ped.2007.106.6.439.
Postoperative epidural morphine is commonly used to control pain in children following dorsal rhizotomy for spasticity. The authors report their experience in using a regimen of scheduled minor analgesic drugs to manage postoperative pain, with the goal of avoiding opiate use following a spinal intradural procedure.
Postoperative pain scores were analyzed in a group of 22 children who underwent a partial dorsal rhizotomy. According to a preestablished standard regimen for postoperative pain control after dorsal rhizotomy, in each patient an intraoperative epidural catheter was placed for the potential infusion of postoperative morphine. Additionally, this cohort underwent a scheduled regimen of acetaminophen (10 mg/kg) and ibuprofen (10 mg/kg), alternating every 2 hours. For comparison, a retrospective chart review was performed in 20 patients with rhizotomies completed prior to the use of this oral analgesic protocol. Only one patient received a postoperative dose of morphine epidurally. None of the remaining patients required postoperative epidural morphine for pain control. Pain scores were significantly lower in this group compared with a retrospective review of patients treated according to the standard regimen. Length of hospital stay was shorter in these patients and antiemetic requirements were lower.
A regimen of minor analgesic therapy, when given in alternating doses every 2 hours immediately after partial dorsal rhizotomy for spasticity and throughout hospitalization, significantly reduced postoperative pain scores, hospitalization, and antiemetic requirements in these patients.
术后硬膜外注射吗啡常用于小儿痉挛性脑瘫行脊髓后根切断术后的疼痛控制。作者报告了他们使用小剂量镇痛药物定时给药方案来控制术后疼痛的经验，目的是避免在脊髓硬膜内手术后使用阿片类药物。
分析了一组22例行部分脊髓后根切断术患儿的术后疼痛评分。根据脊髓后根切断术后预先制定的术后疼痛控制标准方案，为每位患者术中放置硬膜外导管以便术后可能输注吗啡。此外，该队列接受了对乙酰氨基酚（10mg/kg）和布洛芬（10mg/kg）的定时给药方案，每2小时交替使用。作为对照，对在使用该口服镇痛方案之前完成脊髓后根切断术的20例患者进行回顾性病历审查。仅1例患者术后接受了硬膜外吗啡给药。其余患者均无需术后硬膜外注射吗啡来控制疼痛。与按照标准方案治疗的患者回顾性分析相比，该组患者的疼痛评分显著更低。这些患者的住院时间更短，且对止吐药的需求更低。
对于痉挛性脑瘫行部分脊髓后根切断术的患儿，在术后立即及整个住院期间每2小时交替给予小剂量镇痛治疗方案，可显著降低这些患者的术后疼痛评分、缩短住院时间并减少对止吐药的需求。
