Department of Paediatric Surgery, Erasmus University Medical Centre, Sophia Children'sHospital, 3015 GJ Rotterdam, The Netherlands.
Br J Anaesth. 2012 Feb;108(2):295-301. doi: 10.1093/bja/aer421. Epub 2011 Dec 26.
Reports conflict on optimal postoperative analgesic treatment in children with intellectual disability. We retrospectively compared postoperative analgesics consumption between neonates with and without Down's syndrome in relation to anaesthesia requirements and pain scores.
We analysed hypnotic and analgesic drug administration, pain scores [COMFORT-Behaviour (COMFORT-B) scale], and duration of mechanical ventilation during the first 48 h after surgical repair of congenital duodenal obstruction in neonates, between 1999 and 2011. Data of 15 children with Down's syndrome were compared with data of 30 children without Down's syndrome.
General anaesthesia requirements did not differ. The median (inter-quartile range) maintenance dose of morphine during the first 24 h after operation was 9.5 (7.8-10.1) µg kg(-1) h(-1) in the Down's syndrome group vs 7.7 (5.0-10.0) µg kg(-1) h(-1) in the control group (P=0.46). Morphine doses at postoperative day 2 and COMFORT-B scores at day 1 did not significantly differ between the two groups. COMFORT-B scores at day two were lower in children with Down's syndrome (P=0.04). The duration of postoperative mechanical ventilation did not statistically differ between the two groups (P=0.89).
In this study, neonates with and without Down's syndrome received adequate postoperative analgesia, as judged from comparable analgesic consumption and pain scores. We recommend prospective studies in children of different age groups with Down's syndrome and in other groups of intellectually disabled children to provide further investigation of the hypothesis that intellectual disability predisposes to different analgesic requirements.
有关智力障碍儿童术后最佳镇痛治疗的报告存在差异。我们回顾性比较了伴有和不伴有唐氏综合征的新生儿在麻醉需求和疼痛评分方面的术后镇痛药物消耗情况。
我们分析了 1999 年至 2011 年期间先天性十二指肠梗阻新生儿手术修复后 48 小时内镇静和镇痛药物的使用、疼痛评分[舒适行为评分（COMFORT-B 评分）]以及机械通气时间。将 15 例唐氏综合征患儿的数据与 30 例无唐氏综合征患儿的数据进行比较。
全麻需求无差异。术后第 1 天 24 小时内吗啡维持剂量中位数（四分位间距）在唐氏综合征组为 9.5（7.8-10.1）μg·kg-1·h-1，对照组为 7.7（5.0-10.0）μg·kg-1·h-1（P=0.46）。两组第 2 天吗啡剂量和第 1 天 COMFORT-B 评分无显著差异。第 2 天 COMFORT-B 评分在唐氏综合征组较低（P=0.04）。两组术后机械通气时间无统计学差异（P=0.89）。
本研究中，根据相似的镇痛药物消耗和疼痛评分，伴有和不伴有唐氏综合征的新生儿均接受了足够的术后镇痛。我们建议对不同年龄组唐氏综合征患儿和其他智力障碍患儿进行前瞻性研究，以进一步验证智力障碍导致不同镇痛需求的假设。
