小儿单侧腹股沟斜疝修补术术后不同镇痛方法比较

目的观察髂腹股沟/髂腹下神经阻滞与对乙酰氨基酚直肠给药用于小儿疝修补手术后镇痛的效果和安全性。方法选取择期行单侧腹股沟斜疝修补术患儿90例,随机分为神经阻滞组、对乙酰氨基酚组和对照组,各30例。各组患儿行基础麻醉后,神经阻滞组行患侧髂腹股沟/髂腹下神经阻滞;对乙酰氨基酚组经肛门塞入直肠对乙酰氨基酚栓剂;对照组未予任何药物镇痛。分别于术后1、3、6、8h进行疼痛评分,由患儿父母评价总体满意度。记录各组镇痛24h内不良反应发生情况。结果神经阻滞组、对乙酰氨基酚组与对照组比较,患儿术后1、3、6h疼痛评分显著降低,总体满意度显著提高。延迟性股神经阻滞在神经阻滞组较对乙酰氨基酚组、对照组发生例数显著增多(F=4.22P<0.05)。结论髂腹股沟/髂腹下神经阻滞、对乙酰氨基酚直肠给药均可用于小儿疝修补手术后镇痛,效果确切、安全。对乙酰氨基酚直肠给药更易被小儿接受,实施方法简便易行。     

小儿术后镇痛的研究进展

以往多认为小儿神经系统发育不健全，神经敏感性差，对疼痛反应迟钝，故常不重视镇痛工作。现在认为由于发生更剧烈的免疫反应和缺乏中枢抑制因素，婴幼儿有可能经历较成人更痛苦的疼痛。     

腕部神经阻滞在小儿手部手术中的应用（附67例分析）

小儿手部外伤及先天性畸形较常见。手部手术时臂丛神经阻滞效果时有不全。我院将腕部神经阻滞用于小儿手部手术67例，该方法麻醉安全可靠。现报告如下。     

曲马多和吗啡持续静注对小儿术后镇痛比较

由于小儿自身解剖生理的特点,在术后镇痛过程中易出现呼吸抑制。本文通过曲马多和吗啡在小儿术后镇痛中的应用,比较两种药物对小儿呼吸的影响。选择80例ASAⅠ～Ⅲ级病人,随机分为两组,年龄6月～14岁,体重9kg～40kg,两组病种一致。A组40例,用曲马多8mg/(kg·d);B组40例,用吗啡0.18mg/(kg·d),通过镇痛泵从静脉持续     

小儿骶管应用左旋布比卡因复合舒芬太尼对术后镇痛作用的观察

目的 观察小儿骶管应用左旋布比卡因复合舒芬太尼对术后镇痛的影响.方法 收集2010年4月至2011年4月在我院住院的2-6岁择期行下腹部、会阴和下肢手术60例患儿.随机分成左旋布比卡因组（Ⅰ组）和左旋布比卡因复合不同浓度舒芬太尼组（Ⅱ组）和（Ⅲ组）,每组20例.入室后开放静脉通路,监测平均动脉压（MAP）、心率（HR）及脉搏血氧饱和度（SpO2）.麻醉诱导均采用静脉注射氯胺酮1 mg/kg,异丙酚2 mg/kg,置人喉罩进行机械通气.然后行骶管穿刺,成功后Ⅰ组注入0.25％左旋布比卡因,Ⅱ组注入0.25％左旋布比卡因与舒芬太尼0.5μg/ml混合液,Ⅲ组注入0.25％左旋布比卡因与舒芬太尼1.0 μg/ml混合液,三组均按l ml/kg缓慢注入.分别于术后2、4、8、12、16、24h观察镇痛效果,记录镇痛评分、镇痛时间、苏醒时间及不良反应.结果 术后4、8、12 h镇痛评分Ⅱ组和Ⅲ组明显低于Ⅰ组,差异有统计学意义（P＜0.05）;术后8h镇痛评分Ⅲ组低于Ⅱ组,差异有统计学意义（P＜0.05）;术后2、16、24h的镇痛评分三组相比差异无统计学意义（P＞0.05）;Ⅱ组和Ⅲ组的镇痛时间明显长于Ⅰ组（P＜0.05）,Ⅲ组比Ⅱ组的镇痛时间明显延长（P＜0.05）,三组患儿术后苏醒时间差异无统计学意义（P＜0.05）,三组患儿术后均无呼吸抑制.Ⅱ和Ⅲ组各有1例患儿在术后出现面部皮肤瘙痒及1例患儿出现运动阻滞,术后约3h运动功能完全恢复,Ⅲ组有1例患儿在术后出现恶心呕吐.结论 0.25％左旋布比卡因复合0.5 μg/ml及1.0μg/ml舒芬太尼均可安全应用于小儿骶管麻醉及术后镇痛,且可增强术后镇痛效果,延长左旋布比卡因镇痛持续时间,不良反应少,而复合1.0μg/ml舒芬太尼组的术后镇痛效果更好.     

婴幼儿唇裂术后镇痛的临床观察

婴幼儿对疼痛比较敏感 ,但由于种种原因 ,婴幼儿的术后镇痛一直未引起临床上的重视 ,尤其是唇裂患儿术后上唇在进食、表情不断活动等牵拉刀口产生刺激 ,引起剧痛 ,就会发生疼痛 啼哭 疼痛的恶性循环 ,对刀口的愈合十分不利 ,甚至引起刀口出血、裂开、感染等 ,直接影响术后上唇的美观 ,所以对唇裂患儿行术后镇痛对保证手术效果有着重要的意义。本文对唇裂患儿术后镇痛进行了观察 ,现报告如下。资料与方法一、一般资料　我院 2 0 0 1年 6月～ 2 0 0 2年 3月对 78例唇裂修补术后啼哭较剧烈的患儿进行了镇痛治疗 ,月龄 3～15个月 ,男 37例 ,女 4…     

高海拔地区婴幼儿术后镇痛的临床分析

目的 探讨婴幼儿术后采用镇痛方法，使患儿平稳、安全度过术后恢复期。方法 应用药物采取术后镇痛。结果 患儿术后无痛苦，平安度过术后恢复。结论 严格按规章进行，必须要密切观察患儿的BP、P、R、SpO2，并充分给氧，有利术后管理。     

小儿术后镇痛进展

小儿术后疼痛更需治疗,小儿术后镇痛原则是简单、安全、有效、监测。镇痛方法包括简单的镇痛方法,注射镇痛技术(区域神经阻滞镇痛技术、椎管内给药),药物治疗措施(非甾体抗炎镇痛药、阿片类药物)和采取多模式镇痛等方式。     

小儿右侧腹股沟斜疝术后直疝l例

患儿,男,13岁,因右侧腹股沟斜疝术后复发1年余入院。忠儿6岁时被发现其右侧腹股沟有一可复性包块,久立或活动后出现,不坠入阴囊,卧位或按压后消失。于1年前争夺院就诊,诊断为右侧腹股沟斜疝,给予传统开放手术洽疗,术中证实为行侧腹股沟斜疝,并行右侧疝囊高位结扎术。     

Transient femoral nerve block following groin surgery in children

Three cases of transient femoral nerve block following ipsilateral groin surgery in children are presented. All three had received perioperative ilioinguinal nerve blocks using bupivacaine injected medial to the anterior superior iliac spine, which provided excellent analgesia but presumably were responsible for the transient femoral nerve impairment. During the 3-month period of study, this complication accounted for 12% of those in children aged 1–12 years undergoing groin surgery. Lower doses of bupivacaine may provide adequate analgesia for day-case surgery while reducing the incidence of this complication.     

A comparison of analgesic efficacy of tramadol and pethidine for management of postoperative pain in children: a randomized,controlled study

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurrence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences between the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs.     

Sonographic findings following appendectomy for uncomplicated appendicitis in children

Background  Little is known about ‘normal’ local sonographic changes occurring in the postoperative period after an uneventful appendectomy. Objective  To analyse the local changes on US examination occurring after uneventful open (OA) or laparoscopic (LA) appendectomy in children with normal histology and with nonperforated acute appendicitis. Materials and methods  US was prospectively performed in 82 children (54 boys and 28 girls) aged 1–16 years (mean 11.6±3.2 years), 3 days following LA (n=51, 62%) or OA (n=31, 38%) for nonperforated appendicitis. Multivariate analysis was performed using stepwise logistic regression, with the following starting variables: surgical technique, gender, pathological finding, appendix location, and histology. Results  Of the 82 patients, 35 (42.7%) had postoperative pathological US findings such as peritoneal fluid, oedematous mesenteric fat and thickening of the bowel wall. While the overall incidence of pathological US findings between OA and LA groups was not significantly different, multivariate logistic regression analysis showed that OA is associated with a reduction by a factor of 0.35 in the odds ratio of postoperative pathological US findings (P=0.007). Conclusion  Pathological US findings are common in children after appendectomy, particularly after LA. Awareness of these pathological findings might prevent unnecessary postoperative treatment.     

Minimal access surgery for sigmoid volvulus in children

A 12-year-old boy presented with large-bowel obstruction due to sigmoid volvulus. Temporary relief was achieved with rectal tube decompression. Elective laparoscopic-assisted sigmoid colectomy was performed. Post-operative recovery was uneventful. The patient remained well with no recurrence after 4 years of follow-up. Laparoscopic-assisted sigmoid colectomy may be the procedure of choice for selected children with sigmoid volvulus.