Festini Filippo, Dini Donata, Neri Cinzia, Neri Stella
Dipartimento di pediatria, Sezione di Scienze infermieristiche e Professioni sanitarie, Università di Firenze.
Assist Inferm Ric. 2008 Oct-Dec;27(4):197-201.
Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented.
To compare the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers.
Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block. In both groups nurses measured pain with VAS and FLACC scales (score from 0 to 10) for 72 hours after surgery.
41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n = 161, Group B n = 171). Mean pain score of Group A was 0.13 (SD 0.3) and 0.45 (SD 0.8) in group B, p = 0.006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 (SD 1.8) in group B, p = 0.003. In group A the number of pain scores indicating pain (> 0) where 3.1% while in group B were 10.5%, p = 0.0007.
In children undergoing hypospadias surgery, post-operative analgesia with continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times and on demand.
尿道下裂是最常见的先天性畸形之一，约每300例男性出生中就有1例发生。如果不进行手术矫正，其后果可能会对青少年的生活质量产生负面影响。该手术具有很强的侵入性，术后阶段非常疼痛。为了更好地控制术后疼痛，采用了通过硬膜外导管进行持续镇痛的方法。
比较两种不同方案控制疼痛的效果：持续硬膜外导管输注与口服和直肠非甾体类止痛药。
对接受尿道下裂手术的儿童进行比较研究。A组（导管组）术后通过硬膜外导管进行持续镇痛，B组（定时给药组）在骶管阻滞术后按预定时间和按需给予直肠和口服镇痛药。两组护士均在术后72小时内使用视觉模拟评分法（VAS）和面部表情、腿部活动、活动、哭闹、安慰评分法（FLACC）（评分范围为0至10）测量疼痛程度。
共研究了41名儿童（平均年龄64.1个月，标准差47.3），术后有332次疼痛记录（A组n = 161，B组n = 171）。A组的平均疼痛评分为0.13（标准差0.3），B组为0.45（标准差0.8），p = 0.006。硬膜外导管的中位留置时间为65小时，平均51.8小时（标准差24.3）。在术后第一次用药时，A组的平均疼痛评分为1.2（标准差1.4），B组为3.2（标准差1.8），p = 0.003。A组中表示疼痛（> 0）的疼痛评分数量为3.1%，而B组为10.5%，p = 0.0007。
在接受尿道下裂手术的儿童中，与传统的按预定时间和按需口服/直肠镇痛治疗相比，通过硬膜外导管进行持续输注的术后镇痛似乎能提供更好的镇痛效果。
