Rasch D K, Webster D E, Pollard T G, Gurkowski M A
Department of Anesthesiology, University of Texas Health Science Center, San Antonio 78284-7838.
Can J Anaesth. 1990 Apr;37(3):359-62. doi: 10.1007/BF03005591.
Thirty infants scheduled for a variety of gastrointestinal, genitourinary and thoracic surgical procedures were selected for insertion of lumbar or thoracic epidural catheters via the caudal approach using either an Intracath or a Burron continuous brachial plexus kit. The catheters were inserted with ease by residents in training and no catheter-related complications were encountered. Lidocaine 0.5 per cent with 1:200,000 epinephrine was then injected to assure proper placement of the catheter before narcotics were administered. Postoperative analgesia was adequate in all patients using preservative-free morphine 0.05 mg.kg-1. The mean dosing interval was 15 hr and no episodes of nausea, vomiting, hypotension or histamine release were noted. Urinary retention occurred in two infants and one infant became apnoeic three hours after epidural morphine administration but responded to naloxone and pulmonary ventilation with bag and mask. In conclusion, epidural catheters placed via the caudal approach are a safe and effective means of providing postoperative pain control in infants using preservative-free morphine. However, the use of epidural narcotics in infants less than two years of age is restricted to those who will receive intensive care unit monitoring postoperatively so that if apnoea occurs, rapid intervention can be taken by skilled nursing personnel.
选取30例计划接受各种胃肠道、泌尿生殖系统及胸科手术的婴儿，通过骶管途径使用Intracath导管或Burron连续臂丛神经套件插入腰段或胸段硬膜外导管。实习医生轻松完成了导管插入操作，未出现与导管相关的并发症。在给予麻醉药之前，先注射0.5%利多卡因加1:200,000肾上腺素，以确保导管位置正确。所有患者使用不含防腐剂的吗啡0.05 mg.kg-1进行术后镇痛，效果良好。平均给药间隔为15小时，未观察到恶心、呕吐、低血压或组胺释放等情况。两名婴儿出现尿潴留，一名婴儿在硬膜外注射吗啡三小时后出现呼吸暂停，但经纳洛酮治疗及用面罩和气囊进行肺通气后恢复。总之，通过骶管途径放置硬膜外导管是使用不含防腐剂的吗啡为婴儿提供术后疼痛控制的一种安全有效的方法。然而，两岁以下婴儿使用硬膜外麻醉药仅限于术后将接受重症监护病房监测的患者，以便在发生呼吸暂停时，熟练的护理人员能够迅速进行干预。
