Erol Atilla, Tuncer Sema, Tavlan Aybars, Reisli Ruhiye, Aysolmaz Gökhan, Otelcioglu Seref
Department of Anaesthesiology, Meram Medicine Faculty, University of Selcuk, Konya, Turkey.
Pediatr Int. 2007 Dec;49(6):928-32. doi: 10.1111/j.1442-200X.2007.02479.x.
The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children.
The children were premedicated with midazolam 0.5 mg/kg. All children received induction with nitrous oxide and sevoflurane. Anesthesia was maintained with the same volatile agents in the both groups. The children were randomly allocated to two groups. Group I received bupivacaine alone (n = 17) and group II received bupivacaine + sufentanil (n = 16). Caudal block was performed with 0.25% bupivacaine 2 mg/kg (group I) or 0.25% bupivacaine 2 mg/kg with sufentanil 0.5 microg/kg (group II) after induction of anesthesia. Blood samples were obtained after induction of anesthesia (T(0)) to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)).
All of the basal values (T(0)) were within the normal ranges of the authors' laboratory for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) (P < 0.05). The glucose concentration was unchanged at T(2) compared with T(0) in both group (P > 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) and decreased at T(2), compared with T(1) (P < 0.05). Cortisol decreased at T(1) and T(2), compared with T(0) in both groups. (P < 0.05). Insulin concentration remained unchanged at T(0) and T(2), but increased slightly at T(1) in both groups (P > 0.05). There were no significant differences in plasma prolactin, cortisol, glucose and insulin levels between the two groups at T(1) and T(2) (P > 0.05).
There is no advantage in adding 0.5 microg/kg sufentanil to bupivacaine over bupivacaine alone in the caudal block, with regard to the surgical stress response in children.
本随机研究的目的是确定在骶管阻滞中，与单独使用布比卡因相比，在布比卡因中添加舒芬太尼对儿童手术应激反应的影响。
儿童术前用咪达唑仑0.5mg/kg进行预处理。所有儿童均采用氧化亚氮和七氟醚诱导麻醉。两组均用相同的挥发性麻醉剂维持麻醉。儿童被随机分为两组。第一组单独接受布比卡因（n = 17），第二组接受布比卡因+舒芬太尼（n = 16）。麻醉诱导后，第一组用0.25%布比卡因2mg/kg进行骶管阻滞，第二组用0.25%布比卡因2mg/kg加舒芬太尼0.5μg/kg进行骶管阻滞。麻醉诱导后（T(0)）采集血样，测定皮质醇、催乳素、葡萄糖和胰岛素的基线浓度。手术开始30分钟后（T(1)）和手术结束60分钟后（T(2)）采集额外血样。
所有基础值（T(0)）均在作者实验室该年龄组儿童的正常范围内，两组之间无差异（P>0.05）。在两组中，与T(0)和T(2)相比，T(1)时葡萄糖浓度升高（P<0.05）。与T(0)相比，两组在T(2)时葡萄糖浓度无变化（P>0.05）。在两组中，与T(0)相比，T(1)时催乳素浓度升高，与T(1)相比，T(2)时催乳素浓度降低（P<0.05）。与T(0)相比，两组在T(1)和T(2)时皮质醇浓度降低（P<0.05）。两组在T(0)和T(2)时胰岛素浓度保持不变，但在T(1)时略有升高（P>0.05）。两组在T(1)和T(2)时血浆催乳素、皮质醇、葡萄糖和胰岛素水平无显著差异（P>0.05）。
在骶管阻滞中，就儿童手术应激反应而言，在布比卡因中添加0.5μg/kg舒芬太尼并不比单独使用布比卡因更具优势。
