Kim Do-Hyeong, Kim Namo, Lee Jae Hoon, Jo Minju, Choi Yong Seon
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea,
J Pain Res. 2018 Sep 26;11:2061-2070. doi: 10.2147/JPR.S175169. eCollection 2018.
Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.
Patients (N=50, 3-12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively.
Forty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference -1.0, 95% CI -2.0 to -1.0, =0.001 and median difference -2.0, 95% CI -3.0 to -1.0, =0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups.
Intraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.
接受下肢大型骨科手术的儿童术后可能会经历严重疼痛；然而，理想的术后疼痛管理策略尚不清楚。因此，在这一患者群体中，我们研究了术中硬膜外输注局部麻醉药对术后急性疼痛和镇痛药物消耗的影响。
患者（N = 50，3 - 12岁）随机接受0.15%罗哌卡因（超前镇痛组）或生理盐水（对照组）作为初始推注剂量，为0.2 mL/kg，随后在整个手术过程中以0.15 mL/kg/h的速度持续输注。术后，给予0.1%罗哌卡因的患者自控硬膜外镇痛。主要研究结果包括改良的面部、腿部、活动、哭闹及安慰疼痛评分、硬膜外罗哌卡因消耗量以及术后48小时内的额外镇痛需求。
47例患者完成研究，超前镇痛组23例，对照组24例。改良的面部、腿部、活动、哭闹及安慰疼痛评分仅在麻醉后护理单元到达后30分钟和术后6小时时，超前镇痛组显著低于对照组（中位数差异 -1.0，95%可信区间 -2.0至 -1.0，P = 0.001；中位数差异 -2.0，95%可信区间 -3.0至 -1.0，P = 0.005）。然而，术后12、24和48小时时两组间无显著差异。术后48小时内硬膜外罗哌卡因消耗量和额外镇痛需求在两组间无显著差异。
对于接受广泛下肢骨科手术的儿童，术中硬膜外输注罗哌卡因在术后48小时内未显示出超前镇痛效果。
