Mattila Ilkka, Pätilä Tommi, Rautiainen Paula, Korpela Reijo, Nikander Satu, Puntila Juha, Salminen Jukka, Suominen Pertti K, Tynkkynen Paula, Hiller Arja
Division of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Division of Anesthesiology, Hospital for Children and Adolescents, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Paediatr Anaesth. 2016 Jul;26(7):727-33. doi: 10.1111/pan.12919. Epub 2016 May 17.
Postoperative pain after median sternotomy is usually treated with i.v. opioids. We hypothesized that continuous wound infusion of ropivacaine decreases postoperative morphine consumption and improves analgesia in children who undergo cardiac surgery.
This randomized, double-blind study comprised 49 children aged 1-9 years who underwent atrial septal defect (ASD) closure. Patients received continuous local anesthetic wound infiltration either with 0.2% ropivacaine, 0.3-0.4 mg·kg(-1) ·h(-1) (Group R) or with saline (Group C). Rescue morphine consumption, Objective Pain Scale (OPS), time to mobilization, time to enteral food intake, and time to discharge were recorded.
There were no statistically significant differences in morphine consumption at 24, 48, and 72 h postsurgery between R and C groups. There was a weak evidence for a difference in the time to the first morphine administration after tracheal extubation to be longer for Group R than Group C (186.2 vs 81.0 min; 95% CI (-236.5, 26.2), P = 0.114). The incidence of nausea and vomiting were comparable between the groups. No signs or symptoms of local anesthetic toxicity were registered.
Contrary to our hypothesis, continuous ropivacaine wound infusion did not reduce morphine consumption, pain score values, or nausea and vomiting in children who underwent ASD closure with median sternotomy and mediastinal drain.
正中开胸术后疼痛通常采用静脉注射阿片类药物治疗。我们推测，对于接受心脏手术的儿童，持续伤口输注罗哌卡因可减少术后吗啡用量并改善镇痛效果。
这项随机、双盲研究纳入了49例年龄在1至9岁之间接受房间隔缺损（ASD）封堵术的儿童。患者接受持续局部麻醉伤口浸润，其中一组使用0.2%罗哌卡因，剂量为0.3 - 0.4 mg·kg⁻¹·h⁻¹（R组），另一组使用生理盐水（C组）。记录补救性吗啡用量、客观疼痛量表（OPS）、活动时间、开始肠内进食时间和出院时间。
R组和C组术后24、48和72小时的吗啡用量无统计学显著差异。有微弱证据表明，R组气管拔管后首次使用吗啡的时间比C组长（186.2对81.0分钟；95%CI（-236.5，26.2），P = 0.114）。两组恶心和呕吐的发生率相当。未记录到局部麻醉药毒性的体征或症状。
与我们的假设相反，对于接受正中开胸和纵隔引流的ASD封堵术儿童，持续罗哌卡因伤口输注并未减少吗啡用量、疼痛评分值或恶心呕吐的发生。
