Boos K, Beushausen T, Ohrdorf W
Abt. Anästhesie und Intensivmedizin, Kinderkrankenhaus auf der Bult, Hannover.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Aug;31(6):362-7. doi: 10.1055/s-2007-995936.
Continuous epidural anaesthesia is a well established procedure for postoperative analgesia as well as sympathicolysis in adult patients. It is, however, much less frequently reported in infants and children.
From October 1991 to November 1994 65 infants, children and adolescents aged 4 weeks to 19 years, body weight 3.9 kg to 79 kg, received 77 epidural catheters for postoperative analgesia. 54 catheters were inserted via the caudal approach either with (n = 19) or without (n = 35) subcutaneous tunnelling. 23 catheters were placed via a low midline lumbar epidural puncture either through interspace L5/S1 or L4/L5. The local anaesthetic of choice in this study was bupivacaine 0.125% without adrenaline infused continuously via a constant-flow infusion pump. 20 patients received additional boluses of morphine and in 3 patients clonidine was added. The catheters were left in place for an average of 84.5 h. After removal the catheter-tip was submitted for bacteriological examination. The results of 64 specimens were available.
For satisfactory analgesia an average of 0.18 mg x kg-1 x h-1 bupivacaine 0.125% had to be administered via the lumbar route, while the mean dose for caudal catheters was 0.3 mg x kg-1 x h-1. Intestinal peristalsis re-occurred within 33 h after surgery. The first stool was passed within 48 h. Of the 64 catheters which were microbiologically examined, 15 exhibited bacterial colonisation with a statistically significant difference between those subcutaneously tunnelled and those inserted directly (p < 0.05). There were, however, no signs of local or systemic infection.
The results of continuous epidural anaesthesia and sympathicolysis in infants and children are encouraging. This technique is readily employable and complications seem to be rare. Satisfactory analgesia and sympathicolysis were achieved. Based on the results of our bacteriological studies we recommend that caudal catheters are tunnelled subcutaneously in cranio-lateral direction.
连续硬膜外麻醉是成人术后镇痛及交感神经阻滞的一种成熟方法。然而，在婴幼儿和儿童中报道较少。
1991年10月至1994年11月，65例年龄4周至19岁、体重3.9 kg至79 kg的婴幼儿、儿童及青少年接受了77根硬膜外导管用于术后镇痛。54根导管经骶管途径置入，其中19根采用皮下隧道技术，35根未采用。23根导管通过L5/S1或L4/L5椎间隙经低位正中腰椎硬膜外穿刺置入。本研究选用的局麻药为0.125%布比卡因，不加肾上腺素，通过恒流输液泵持续输注。20例患者额外给予吗啡推注，3例患者加用可乐定。导管平均留置84.5小时。拔除后，将导管尖端送检进行细菌学检查。64份标本有结果。
为达到满意镇痛，经腰椎途径平均需输注0.125%布比卡因0.18 mg·kg⁻¹·h⁻¹，而骶管导管的平均剂量为0.3 mg·kg⁻¹·h⁻¹。术后33小时内肠道蠕动恢复。首次排便在48小时内。在64根接受微生物学检查的导管中，15根出现细菌定植，皮下隧道技术置入的导管与直接置入的导管之间存在统计学显著差异（p<0.05）。然而，没有局部或全身感染的迹象。
婴幼儿和儿童连续硬膜外麻醉及交感神经阻滞的结果令人鼓舞。该技术易于应用，并发症似乎很少。实现了满意的镇痛和交感神经阻滞。基于我们的细菌学研究结果，我们建议骶管导管沿颅外侧方向进行皮下隧道置入。
