Palma Amy, Viegas Jacqueline, Manlhiot Cedric, McCrindle Brian, Benson Lee
Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Catheter Cardiovasc Interv. 2016 Feb 1;87(2):318-23. doi: 10.1002/ccd.26284. Epub 2015 Nov 3.
To investigate the effects of local infiltration of 0.25% bupivacaine on post-operative pain and analgesic use in children undergoing cardiac catheterization procedures.
In pediatric catheterization procedures performed under general anesthesia, a local anesthetic is often used prior to femoral sheath removal. There are no published reports of the impact of local anesthetic infiltration on pain after pediatric procedures, and mixed reports on its effectiveness in adults.
A randomized controlled trial was undertaken of 140 children, aged 7-18 years undergoing cardiac catheterization under general anesthesia via the femoral vein or artery. Participants received a subcutaneous infiltration of 0.25% bupivacaine at the access site prior to sheath removal, or usual care without bupivacaine. Outcomes included patient reported pain scores and analgesic use up to 6 hr after the procedure.
Pain scores were similar between groups through the 6-hr post-procedure period. The proportion of children reporting a maximal pain score of ≤2/10 was higher in the bupivacaine group (64% vs. 44%, P = 0.03). A significantly higher proportion of children in the control group required IV morphine (18.8% vs. 4.5%, P = 0.02).
Morphine use can be reduced with the use of 0.25% bupivacaine given prior to femoral sheath removal and should be considered for post-procedural pain control for pediatric patients undergoing cardiac catheterization. This study is the first to contribute evidence to the effectiveness of 0.25% bupivacaine after pediatric cardiac catheterization.
探讨0.25%布比卡因局部浸润对接受心脏导管插入术儿童术后疼痛及镇痛药物使用的影响。
在全身麻醉下进行的儿科导管插入术中，常在拔除股动脉鞘管前使用局部麻醉药。目前尚无关于局部麻醉药浸润对儿科手术后疼痛影响的报道，且关于其在成人中的有效性报道不一。
对140名年龄在7至18岁、在全身麻醉下经股静脉或动脉进行心脏导管插入术的儿童进行了一项随机对照试验。参与者在拔除鞘管前在穿刺部位接受0.25%布比卡因皮下浸润，或接受不使用布比卡因的常规护理。观察指标包括患者报告的疼痛评分以及术后6小时内的镇痛药物使用情况。
在术后6小时内，两组的疼痛评分相似。布比卡因组报告最大疼痛评分为≤2/10的儿童比例更高（64%对44%，P = 0.03）。对照组中需要静脉注射吗啡的儿童比例显著更高（18.8%对4.5%，P = 0.02）。
在拔除股动脉鞘管前使用0.25%布比卡因可减少吗啡的使用，对于接受心脏导管插入术的儿科患者的术后疼痛控制应考虑使用。本研究首次为0.25%布比卡因在儿科心脏导管插入术后的有效性提供了证据。
