罗哌卡因复合小剂量吗啡用于小儿尿道下裂术后骶管阻滞镇痛的临床研究

张永发 游志坚 吴少坪

汕头大学医学院第二附属医院麻醉科，广东汕头 515041

[摘要] 目的 比较单纯罗哌卡因和罗哌卡因复合小剂量吗啡用于小儿尿道下裂术后骶管阻滞镇痛的效果。 方法 选择ASA分级Ⅰ～Ⅱ级的择期男性尿道下裂患儿50例，随机分成单纯罗哌卡因组（R组）和罗哌卡因复合吗啡组（RM组），每组25例。R组全麻诱导后用0.25%罗哌卡因0.5mL/kg进行骶管阻滞，RM组用0.25%罗哌卡因0.5mL/kg复合吗啡7.5µg/kg进行骶管阻滞。记录两组患儿手术、麻醉以及镇痛时间。术后24h内记录不良副作用的发生率。结果 R组平均镇痛时间为（9.8±2.6）h，RM组镇痛时间为（16.2±3.4）h，两组比较差异有统计学意义（t=7.476，P＜0.05）。两组患儿的手术时间、麻醉时间相似（P＞0.05）。两组并发症发生率比较，差异无统计学意义（x2=0.189，P＞0.05）。 结论 0.25%罗哌卡因复合小剂量吗啡7.5µg/kg用于小儿尿道下裂术后骶管阻滞镇痛，镇痛时间长，效果确切，没有明显副作用。

[关键词] 骶管阻滞；尿道下裂手术；罗哌卡因；吗啡

[中图分类号] R726.1   [文献标识码] B   [文章编号] 2095-0616（2014）11-95-03

Clinical study on caudal ropivacaine plus little dose of morphine for postoperative analgesia in children undergoing hypospadias surgery

ZHANG Yongfa  YOU Zhijian  WU Shaoping

Department of Anesthesiology, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, China

[Abstract] Objective To compare the effectiveness of caudal ropivacaine and ropivacaine plus little dose of morphine for postoperative analgesia in children undergoing hypospadias surgery. Methods Fifty ASA I-Ⅱ male children undergoing elective hypospadias surgery were randomly divided into two groups, 25 patients in each group. Patients in group R (ropivacaine) were given 0.5mL/kg of 0.25% plain ropivacaine, while patients in group RM (ropivacaine and morphine) were given 0.5 mL/kg of 0.25% ropivacaine in combination with 7.5µg/kg of morphine in caudal epidural space just after induction of general anesthesia. Duration of surgery, anesthesia, and analgesia were recorded. Unwanted side effects were also recorded for 24 hours postoperatively. Results The mean duration of analgesia was (9.8±2.6)h in the R group compared with (16.2±3.4)h in the RM group (t=7.476,P＜0.05). Duration of surgery were similar between two groups (P＞0.05). About the incidence of complications, there was not statistically significant(x2=0.189,P＞0.05). Conclusion Caudal morphine 7.5µg/kg in 0.25% ropivacaine provides prolonged and good quality postoperative analgesia without significant side-effects in children undergoing hypospadias surgery.

[Key words] Caudal block; Hypospadias surgery; Ropivacaine; Morphine

术后急性疼痛不仅使小儿感觉痛苦，还会带来一系列的生理和心理反应，增加术后并发症的发生率，影响小儿术后恢复；同时，还可能会造成长远的心理影响，增加术后慢性疼痛的发生率[1]。因此，麻醉医师必须积极治疗小儿术后疼痛。骶管阻滞是小儿外科最常用的术中及术后局部镇痛技术之一[2]。骶管阻滞的主要缺点是单次注射局麻药后镇痛作用时间相对较短。留置导管反复或持续注射局麻药又容易增加感染的风险。为延长单次阻滞的镇痛时间，麻醉医师常常选用长效局麻药或向局麻药添加阿片类镇痛药[3-4]。……