Department of Anesthesiology and Surgery, Santa Casa de Misericórdia, Belo Horizonte, Minas Gerais, Brazil.
J Anesth. 2012 Apr;26(2):213-8. doi: 10.1007/s00540-011-1297-y. Epub 2011 Dec 10.
We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures.
Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 μg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg and clonidine 1.0 μg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded.
The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05).
To conclude, we showed that 20 μg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 μg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.
本研究旨在评估在小儿下腹部泌尿科和生殖器手术中，布比卡因中加入吗啡、可乐定或吗啡加可乐定对术后镇痛的影响。
本研究共纳入 80 名年龄在 1-10 岁的患儿，在全麻诱导后，将患儿随机分为 4 组进行骶管麻醉：B 组（1.0 mL/kg 0.166%布比卡因加肾上腺素 1:600,000）；BM 组（1.0 mL/kg 0.166%布比卡因加肾上腺素 1:600,000 加吗啡 20 μg/kg）；BC 组（0.166%布比卡因加肾上腺素 1:600,000 加可乐定 1.0 μg/kg）；BMC 组（0.166%布比卡因加肾上腺素 1:600,000 加吗啡 20 μg/kg 和可乐定 1.0 μg/kg）。记录手术时间、苏醒时间、术后 24 小时内用面部、腿部、活动、哭闹、安抚（FLACC）评分测量的术后疼痛评分、术后镇痛时间以及整体使用补救性镇痛药的情况。
术后 6、12 和 24 小时，B 组和 BC 组的 FLACC 疼痛评分（术后 24 小时）和术后 24 小时内需要镇痛药的患者人数均高于 BM 组和 BMC 组（p < 0.05）。各组之间瘙痒和尿潴留的发生率无差异（p > 0.05）。然而，BM 组（35%）和 BMC 组（25%）的术后恶心和呕吐（PONV）发生率高于 B 组（5%）和 BC 组（5%）（p < 0.05）。
总之，我们发现 0.166%布比卡因加肾上腺素 1:600,000 中加入 20 μg/kg 吗啡可减少术后镇痛药物的使用，但与 PONV 发生率增加有关。然而，布比卡因中加入可乐定（1.0 μg/kg）与单独使用布比卡因相比，没有提供额外的临床益处。
