Shrestha S K, Bhattarai B
Department of Anesthesiology, Dhulikhel Hospital, Nepal Health Research Council Hospital, Dhulikhel, Kavre, Nepal.
J Nepal Health Res Counc. 2010 Oct;8(2):99-102.
Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration of tramadol seemed to be a safe method of analgesia. The aim of the study is to compare the analgesic efficacy of caudal bupivacaine and bupivacaine and tramadol mixture for postoperative analgesia and to observe for side effects.
Forty children, aged between 1- 6 years undergoing infra umbilical surgeries were selected for this randomized, control trial. They were randomly divided into two groups. Group A (n = 20) received 0.5 ml/kg of 0.25 % bupivacaine and Group B (n = 20) received 0.5 ml/kg of 0.25 % bupivacaine with 1 mg/kg of tramadol as a single shot caudal block. In the postoperative period heart rate, respiratory rate, pain score, recovery to first analgesic time, total number of analgesics required in 24 hours and side effects were noted and analyzed.
It was observed that the mean duration of pain relief was significantly longer in Group B (8.8 hrs Vs 7 hrs). Nausea and vomiting was observed in 25% of the patients in group B and 20 % of the patients in group A. None of the patients in both the groups had complication like motor weakness, urinary retention in the postoperative period.
The addition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesic in the postoperative period compared to bupivacaine.
布比卡因用于小儿骶管阻滞镇痛较为常用，而曲马多硬膜外给药似乎是一种安全的镇痛方法。本研究旨在比较骶管注射布比卡因与布比卡因联合曲马多用于术后镇痛的效果，并观察其副作用。
选取40例年龄在1至6岁之间接受脐下手术的儿童进行这项随机对照试验。他们被随机分为两组。A组（n = 20）接受0.5 ml/kg的0.25%布比卡因，B组（n = 20）接受0.5 ml/kg的0.25%布比卡因加1 mg/kg曲马多进行单次骶管阻滞。术后记录并分析心率、呼吸频率、疼痛评分、首次镇痛恢复时间、24小时内所需镇痛药物总数及副作用。
观察发现，B组的平均镇痛持续时间明显更长（8.8小时对7小时）。B组25%的患者和A组20%的患者出现恶心和呕吐。两组患者术后均未出现运动无力、尿潴留等并发症。
与单纯使用布比卡因相比，在骶管镇痛技术中加入曲马多可提供更长时间的镇痛效果，且术后对补救性镇痛的需求更少。
