Locatelli B G, Frawley G, Spotti A, Ingelmo P, Kaplanian S, Rossi B, Monia L, Sonzogni V
Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Br J Anaesth. 2008 May;100(5):701-6. doi: 10.1093/bja/aen048. Epub 2008 Mar 15.
Ketamine is used increasingly in paediatric anaesthetic practice to prolong the action of a caudal block. This study was designed to determine if adding S(+)-ketamine 0.5 mg kg(-1) allows a lower concentration of levobupivacaine to be used for caudal anaesthesia without loss of clinical effectiveness.
One hundred and sixty-four children (ASA I or II) aged 3 months-6 yr were randomly allocated to receive 1 ml kg(-1) of levobupivacaine 0.15% with 0.5 mg kg(-1) S(+)-ketamine (Group 1), levobupivacaine 0.175% with 0.5 mg kg(-1) S(+)-ketamine (Group 2), or levobupivacaine 0.2% (Group 3) by the caudal route. Pain, motor block, sedation, and requirement for postoperative analgesia were assessed up to 6 h after operation.
There was no significant difference between the groups in effectiveness at first surgical incision. Significantly lower analgesic requirements were reported in Group 2 compared with Group 3 at wakeup, 180 and 360 min after operation. Time to first rescue analgesia was longer in Group 2 compared with Group 1 or 3. Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of Group 2 over Groups 1 and 3 (log rank P=0.05). The incidence of postoperative motor block was not significantly different between the groups. No excess sedation or dysphoric reactions were observed in the ketamine groups.
The addition of 0.5 mg kg(-1) S(+)-ketamine to levobupivacaine 0.175% for caudal analgesia for lower abdominal and urological surgery is significantly more effective in providing postoperative analgesia than levobupivacaine 0.15% with 0.5 mg kg(-1) S(+)-ketamine or levobupivacaine 0.2%.
氯胺酮在小儿麻醉实践中越来越多地用于延长骶管阻滞的作用时间。本研究旨在确定添加0.5mg/kg的S(+)-氯胺酮是否能在不降低临床效果的情况下，使较低浓度的左旋布比卡因用于骶管麻醉。
164例年龄在3个月至6岁的儿童（ASA I或II级）被随机分配，通过骶管途径接受1ml/kg的0.15%左旋布比卡因加0.5mg/kg S(+)-氯胺酮（第1组）、0.175%左旋布比卡因加0.5mg/kg S(+)-氯胺酮（第2组）或0.2%左旋布比卡因（第3组）。术后长达6小时评估疼痛、运动阻滞、镇静及术后镇痛需求。
在首次手术切口时，各组间效果无显著差异。与第3组相比，第2组在术后苏醒时、术后180分钟和360分钟时的镇痛需求显著更低。与第1组或第3组相比，第2组至首次补救镇痛的时间更长。镇痛无时间的Kaplan-Meier生存分析显示第2组优于第1组和第3组（对数秩检验P=0.05）。各组间术后运动阻滞发生率无显著差异。在氯胺酮组未观察到过度镇静或烦躁反应。
对于下腹部和泌尿外科手术的骶管镇痛，在0.175%左旋布比卡因中添加0.5mg/kg S(+)-氯胺酮在提供术后镇痛方面比0.15%左旋布比卡因加0.5mg/kg S(+)-氯胺酮或0.2%左旋布比卡因显著更有效。
