Kerschbaum G, Altmeppen J, Funk W, Taeger K
Klinik für Anästhesiologie, Klinikum der Universität Regensburg.
Anaesthesist. 1998 Mar;47(3):238-42. doi: 10.1007/s001010050552.
We report the case of a 3-year-old boy, who received long-term parent-controlled analgesia after traumatic amputation of one leg. He underwent surgery 17 times for a period of 25 days. Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics (acetaminophen) proved to be insufficient. The pump was set to a bolus-dose of 23 micrograms kg-1 piritramide (dipidolor) and a lockout interval of 10 minutes. Permitted maximum cumulative dose in four hours was 5 mg piritramide. There was no continuous infusion of opioid. PCA and possible adverse effects were explained to the mother. A monitoring regimen was used to assess efficacy (pain intensity estimated by the mother), adverse effects (sedation score, occurrence of nausea and vomiting) and piritramide consumption. For fear of side effects opioid administration was insufficient in the beginning. After three days the mother used the PCA effectively and no additional analgesic medication was required. Nausea or other side effects were not observed. After seven days opioid consumption nearly doubled. Apart from tolerance, this might have resulted from the mother's caution in the first days. After 17 days the PCA was discontinued. Oral analgetics (tramadol) controlled the pain adequately. Management of postoperative pain in children is difficult and too often insufficient. PCA is a safe and effective method of providing postoperative pain relief. Feasibility was shown in adolescents and, more recently, in children aged five years and over. Only few reports are available describing long term use of PCA in children younger than five years. Our case suggests that PCA may also be used effectively and safely in children younger than five years, if experienced staff, a monitoring regimen and cooperative and well instructed parents are available.
我们报告了一名3岁男孩的病例，该男孩在单腿外伤性截肢后接受了长期的家长控制镇痛。在25天的时间里，他接受了17次手术。入院四天后开始采用家长控制镇痛，因为事实证明使用非阿片类镇痛药（对乙酰氨基酚）镇痛效果不足。镇痛泵设定的哌替啶（度冷丁）单次剂量为23微克/千克，锁定时间间隔为10分钟。四小时内允许的最大累积剂量为5毫克哌替啶。没有持续输注阿片类药物。向患儿母亲解释了患者自控镇痛（PCA）及其可能的不良反应。采用了一种监测方案来评估疗效（由母亲估计的疼痛强度）、不良反应（镇静评分、恶心和呕吐的发生情况）以及哌替啶的使用量。由于担心副作用，起初阿片类药物的使用量不足。三天后，患儿母亲有效地使用了PCA，不再需要额外的镇痛药物。未观察到恶心或其他副作用。七天后，阿片类药物的使用量几乎增加了一倍。除了耐受性外，这可能是由于患儿母亲在最初几天较为谨慎所致。17天后停用了PCA。口服镇痛药（曲马多）足以控制疼痛。儿童术后疼痛的管理很困难，而且往往不够充分。PCA是一种安全有效的术后镇痛方法。在青少年中已证明其可行性，最近在5岁及以上的儿童中也得到了验证。关于5岁以下儿童长期使用PCA的报道很少。我们的病例表明，如果有经验丰富的工作人员、监测方案以及合作且受过良好指导的家长，PCA在5岁以下儿童中也可有效且安全地使用。
