Bozkurt P, Kaya G, Yeker Y
Department of Anesthesiology, Istanbul University, Cerrahpaşa Medical Faculty, Turkey.
Reg Anesth. 1997 May-Jun;22(3):212-7. doi: 10.1016/s1098-7339(06)80003-9.
Since the first report of epidural opioid administration to pediatric patients, several studies have described the quality of analgesia, doses, pharmacokinetics, and side effects of this procedure. A pediatric series using an easy and cheap single-injection technique of epidural morphine administration for postoperative analgesia is presented.
Postoperative analgesia was achieved with a single lumbar epidural morphine injection (0.1 mg/kg in 0.2 mL/kg saline), which was given via a 22-gauge intramuscular needle to 153 pediatric patients (aged 4 months-17 years) following 175 lower abdominal or urologic operations. Injections were given by 43 anesthesiology residents under the supervision of pediatric anesthesiologists, after termination of surgery performed under general anesthesia.
The success rate of epidural puncture on the first attempt was 92%. Pain control was considered excellent in 76% of patients for 24 hours. The remaining patients had analgesia lasting 10.9 +/- 5.5 hours after epidural morphine administration. No alterations in hemodynamic parameters were observed. Two patients (1.1%) developed respiratory depression during early postoperative care and one, with a history of apneic spells, had an episode of apnea 5 hours after morphine administration. The incidences of minor side effects were: nausea, 33.9%; vomiting, 42.9%; pruritus 9%; and urinary retention 12.5%.
This technique is easy to perform, even for trainees in anesthesiology. With appropriate patient selection and avoidance of the concomitant use of narcotics and sedatives, epidural morphine provides prompt, effective, safe, and prolonged analgesia in children.
自首次报道对儿科患者进行硬膜外给予阿片类药物以来，已有多项研究描述了该操作的镇痛质量、剂量、药代动力学及副作用。本文介绍了一项儿科研究系列，采用简便且廉价的单次注射技术进行硬膜外吗啡给药以用于术后镇痛。
对153例（年龄4个月至17岁）接受175例下腹部或泌尿外科手术的儿科患者，在全身麻醉手术结束后，通过22号肌内注射针给予单次腰椎硬膜外吗啡注射（0.1 mg/kg溶于0.2 mL/kg生理盐水中）。注射由43名麻醉科住院医师在儿科麻醉医师的监督下进行。
首次硬膜外穿刺成功率为92%。76%的患者疼痛控制在24小时内被认为极佳。其余患者在硬膜外给予吗啡后镇痛持续时间为（10.9±5.5）小时。未观察到血流动力学参数的改变。两名患者（1.1%）在术后早期护理期间出现呼吸抑制，一名有呼吸暂停发作史的患者在给予吗啡5小时后出现一次呼吸暂停。轻微副作用的发生率分别为：恶心33.9%；呕吐42.9%；瘙痒9%；尿潴留12.5%。
即使对于麻醉学实习生而言，该技术也易于实施。通过适当选择患者并避免同时使用麻醉药和镇静剂，硬膜外吗啡可为儿童提供迅速、有效、安全且持久的镇痛。
