Rosen K R, Rosen D A
Department of Anesthesiology, C. S. Mott Children's Hospital, Ann Arbor, Michigan 48109-0800.
Anesthesiology. 1989 Mar;70(3):418-21. doi: 10.1097/00000542-198903000-00009.
The safety and efficacy of epidural morphine injected into the caudal space for control of postoperative pain following open cardiac surgery in children was studied. Thirty-two children between the ages of 2-12 yr for whom early postoperative tracheal extubation was anticipated were randomly assigned to control and study groups. Study subjects received a caudal injection of preservative free morphine sulfate (0.075 mg/kg) in preservative-free normal saline (5-10 ml) following completion of surgery, but prior to awakening and extubation of the trachea. Supplemental intravenous morphine administration and pain scores were recorded for 24 h. Patients in the study group received significantly less (P less than 0.03) morphine (0.32 mg.kg-1.24 h-1) and had significantly lower pain scores than did patients in the control group (0.71 mg.kg-1.24 h-1). The mean duration of complete analgesia in patients receiving caudally administered morphine was 6 h (range 2-12), but decreased analgesic requirements were noted for the entire 24 h. No respiratory depression was evident by clinical variables or repeated arterial blood gas values. Nausea without vomiting occurred in 4/16 patients in the study group. No patient described pruritus. The authors were unable to evaluate the occurrence of urinary retention because all patients had indwelling urinary catheters. They found caudal epidural morphine to be safe and effective in the treatment of postoperative pain in children following open heart surgery.
研究了将硬膜外吗啡注入骶管腔用于控制儿童心脏直视手术后疼痛的安全性和有效性。32名年龄在2至12岁之间、预计术后早期气管拔管的儿童被随机分为对照组和研究组。研究对象在手术结束后、苏醒和气管拔管前，于骶管内注射不含防腐剂的硫酸吗啡（0.075mg/kg），溶入不含防腐剂的生理盐水（5 - 10ml）中。记录24小时内静脉补充吗啡的用量和疼痛评分。研究组患者接受的吗啡量显著较少（P小于0.03）（0.32mg·kg⁻¹·24h⁻¹），且疼痛评分显著低于对照组患者（0.71mg·kg⁻¹·24h⁻¹）。接受骶管注射吗啡患者的完全镇痛平均持续时间为6小时（范围2 - 12小时），但在整个24小时内镇痛需求均有所降低。临床指标或重复动脉血气值均未显示明显的呼吸抑制。研究组16名患者中有4名出现无呕吐的恶心。没有患者描述有瘙痒症状。由于所有患者均留置导尿管，作者无法评估尿潴留的发生情况。他们发现骶管硬膜外吗啡在治疗儿童心脏直视手术后的疼痛方面是安全有效的。
