艾司氯胺酮用于小儿尿道下裂患者术后镇痛的安全性和有效性。

Safety and efficacy of esketamine for postoperative analgesia in pediatric patients with hypospadias.

作者信息

Xu Yong, Chen Quan, Li Ping, Song Xingrong

机构信息

Department of Anesthesiology, The First School of Clinical Medicine of Jinan University, Guangzhou, China.

Department of Anesthesiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.

出版信息

Front Surg. 2023 Apr 4;10:1131137. doi: 10.3389/fsurg.2023.1131137. eCollection 2023.

DOI:10.3389/fsurg.2023.1131137

PMID:37082363

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10110919/

Abstract

OBJECTIVE

To explore the safety and efficacy of the combination of continuous intravenous infusion of esketamine with sacral block for postoperative analgesia in pediatric patients undergoing surgery for hypospadias.

METHODS

Pediatric patients (= 77) undergoing surgery for hypospadias were randomized into two groups: a hydromorphone group (H group, initial dose, 0.02 mg/kg; maintenance dose, 0.01 mg/kg/h) or an esketamine group (E group, initial dose, 0.3 mg/kg; maintenance dose 0.15 mg/kg/h). Caudal epidural block involved injection of 0.2% ropivacaine 1 ml/kg through the sacral hiatus. Age, weight, grade of hypospadias, intraoperative blood loss, operative time, and awaking time of patients were recorded. The Face, Legs, Activity, Cry and Consolability (FLACC) scale and Ramsay sedation scores were recorded when leaving the PACU (0 h) and at postoperative 2, 6, 12, 24, 36, and 48 h. The Pediatric Anesthesia Emergence Delirium Scale (PAED), incidence of hypotension, respiratory depression, nausea and vomiting and pruritus, and the time to first bowel movement after surgery were recorded.

RESULTS

There were no significant differences in demographic and clinical characteristics between the H group and the E group. There were no significant differences in FLACC scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in intra-group and inter-group comparisons. There were no significant differences in Ramsay sedation scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in the intra-group comparisons. Ramsay sedation scores were significantly lower at postoperative 2, 12, and 36 h in the H group compared to the E group. There were no significant differences in the PAED scale or incidence of nausea and vomiting or pruritus between the H group and the E group. The incidence of hypotension and respiratory depression was significantly lower, and the time to first bowel movement was significantly shorter in the E group compared to the H group. Urinary tryptophan, 5-hydroxytryptamine and substance P levels were significantly lower but arginine was significantly higher in the E group compared to the H group.

CONCLUSIONS

The combination of continuous intravenous infusion of esketamine with sacral block provided safe and effective postoperative analgesia for pediatric patients undergoing surgery for hypospadias.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR2200066967. Clinical trial registry URL: http://www.chictr.org.cn/edit.aspx?pid=185042&htm=4.

摘要

目的

探讨右美沙芬持续静脉输注联合骶管阻滞用于小儿尿道下裂手术术后镇痛的安全性和有效性。

方法

将77例行尿道下裂手术的小儿患者随机分为两组：氢吗啡酮组（H组，初始剂量0.02 mg/kg；维持剂量0.01 mg/kg/h）和右美沙芬组（E组，初始剂量0.3 mg/kg；维持剂量0.15 mg/kg/h）。骶管硬膜外阻滞是通过骶裂孔注射0.2%罗哌卡因1 ml/kg。记录患者的年龄、体重、尿道下裂分级、术中出血量、手术时间和苏醒时间。在离开麻醉后恢复室（0小时）以及术后2、6、12、24、36和48小时记录面部、腿部、活动、哭闹和安慰性（FLACC）量表评分和 Ramsay 镇静评分。记录小儿麻醉苏醒期谵妄量表（PAED）、低血压、呼吸抑制、恶心呕吐和瘙痒的发生率，以及术后首次排便时间。

结果

H组和E组在人口统计学和临床特征方面无显著差异。组内和组间比较，术后0、2、6、12、24、36和48小时的FLACC评分无显著差异。组内比较，术后0、2、6、12、24、36和48小时的Ramsay镇静评分无显著差异。与E组相比，H组术后2、12和36小时的Ramsay镇静评分显著更低。H组和E组在PAED量表、恶心呕吐或瘙痒发生率方面无显著差异。与H组相比，E组低血压和呼吸抑制的发生率显著更低，首次排便时间显著更短。与H组相比，E组尿色氨酸、5-羟色胺和P物质水平显著更低，但精氨酸水平显著更高。