A comparison of single dose caudal tramadol, tramadol plus bupivacaine and bupivacaine administration for postoperative analgesia in children

BACKGROUND: Our aim was to compare the effect of single dose caudal tramadol, tramadol plus bupivacaine and bupivacaine on the management of postoperative pain in children. METHODS: Sixty-three children in ASA groups I-II, between the ages of 1 and 5 were evaluated for postoperative pain randomly divided into three groups as follows: In group T, only tramadol was given caudally; in group TB, tramadol-bupivacaine was given caudally; in group B, bupivacaine was given alone. Pain was evaluated by using the paediatric objective pain scale (POPS). Sedation was evaluated with a 5-point test. There were no differences with age, weight, haemodynamic and respiratory parameters between groups. RESULTS: For 24 h postoperatively, the POPS value showed no statistically significant difference among groups (P > 0.05). Postoperative analgesia was maintained for 24 h. Nausea and vomiting was found to be higher in the tramadol group than in the bupivacaine group and tramadol-bupivacaine group (P < 0.001 and P < 0.01, respectively). CONCLUSION: Tramadol used caudally is as effective as bupivacaine in the management of postoperative pain in children and the addition of tramadol to bupivacaine, when both drugs were administered caudally, did not prolong the duration of action of bupivacaine and is a safe agent in children.     

Intrathecal sufentanil and morphine for post-thoracotomy pain relief

In this double-blind randomized study we compared a group of15 patients undergoing thoracotomy who received a spinal injectionof sufentanil 20 µg combined with morphine (200 µg)after induction of general anaesthesia with a control groupof the same size. Post-operative pain was rated on a visualanalogue scale (VAS) and a verbal rating scale at rest and witha VAS on coughing. In the recovery room, patients received titratedi.v. morphine until the VAS score was <30, and were followedby patient-controlled analgesia (PCA) for 72 h. The intrathecalsufentanil and morphine group had a lower intra-operative requirementfor i.v. sufentanil and needed less i.v. morphine for titrationin the recovery room. I.v. PCA morphine consumption and painscores were lower in the active group than in the control groupduring the first 24 h. There were no differences afterthis time. Spirometric data (peak expiratory flow, forced vitalcapacity and forced expiratory volume in 1 s) were similarin the two groups. We conclude that the combination of intrathecalsufentanil and morphine produces analgesia of rapid onset andwith a duration of 24 h. Br J Anaesth 2001; 86: 236–40.     

Codeine phosphate in paediatric medicine

Br J Anaesth 2001; 86: 413–21     

Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study

This multi-centre, parallel group, randomized, double-blindstudy compared the efficacy and safety of high-dose remifentaniladministered by continuous infusion with an intermittent bolusfentanyl regimen, when given in combination with propofol forgeneral anaesthesia in 321 patients undergoing elective coronaryartery bypass graft surgery. A significantly lower proportionof the patients who received remifentanil had responses to maximalsternal spread (the primary efficacy endpoint) compared withthose who received fentanyl (11% vs 52%; P<0.001). More patientswho received remifentanil responded to tracheal intubation comparedwith those who received fentanyl (24% vs 9%; P<0.001). However,fewer patients who received remifentanil responded to sternalskin incision (11% vs 36%; P<0.001) and sternotomy (14% vs60%; P <0.001). Median time to extubation was longer in thesubjects who received remifentanil than for those who receivedfentanyl (5.1 vs 4.2 h; P=0.006). There were no statisticallysignificant differences between the two groups in the timesfor transfer from intensive care unit or hospital dischargebut time to extubation was significantly longer in the remifentanilgroup. Overall, the incidence of adverse events was similarbut greater in the remifentanil group with respect to shivering(P<0.049) and hypertension (P<0.001). Significantly moredrug-related adverse events were reported in the remifentanilgroup (P=0.016) There were no drug-related adverse cardiac outcomesand no deaths from cardiac causes before hospital dischargein either treatment group. Br J Anaesth 2001; 87: 718–26     

心脏病患者围手术期血浆胶体渗透压测定及临床意义

心脏手术期间患者血浆胶体渗透压(COP)的变化不可避免,但血浆COP对机体重要器官影响很大,直接测定血浆COP的技术引进后,使得临床连续测定血浆COP成为可能。本文就血浆COP的测定方法及临床意义进行综述。     

硬膜外自控镇痛在下肢闭合性骨折患者术前镇痛中的应用

目的探讨在下肢闭合性骨折患者中应用硬膜外自控镇痛(PCEA)进行手术前镇痛的效果。方法将60例患者随机分为观察组和对照组,每组30例,分别予以PCEA和传统止痛方式进行术前镇痛,通过对2组镇痛效果、生理指标、心理状态的比较,以及观察不良反应和硬膜外导管污染的测定,评价PCEA在术前镇痛中应用的优势。结果观察组镇痛效果明显好于对照组,VAS≤3分的百分率(%);静卧时分别为98.3vs78.4,活动时为86.7vs38.6(P均<0.05),生理指标除SpO2外MAP、HR、RR也较对照组更为平稳(P均<0.05),术前焦虑情绪的改善较对照组显著(P均<0.05),未发现不良反应,硬膜外导管细菌培养阴性。结论应用PCEA对下肢闭合性骨折患者进行术前镇痛效果满意,同时能显著减轻患者的焦虑及抑郁情绪,有利于术前准备。     

异丙酚复合不同镇痛药用于老年患者妇科门诊手术麻醉的观察

目的研究异丙酚复合不同镇痛药用于老年患者妇科门诊手术的麻醉作用。方法年龄55岁以上ASA分级Ⅰ～Ⅲ患者80例，随机分4组（n=20），Ⅰ组先缓慢静脉注射芬太尼1μg／kg1min后静脉注射异丙酚2mg／kg。Ⅱ组先静脉注射曲马多1mg／kg1min后静脉注射异丙酚2mg／kg。Ⅲ组先静脉注射氯诺昔康0．15mg／kg5min后静脉注射异丙酚2mg／kg，Ⅳ组静脉注射异丙酚2mg／kg。四组异丙酚静注速率均为100mg／min。观察各组诱导及苏醒时间，用药总量，记录术中呼吸、循环参数改变和术中、术后不良反应。术后由手术医生评定麻醉效果。结果手术全程异丙酚给药量及术毕至唤醒时间对照组高于其他各组。Ⅰ组术中最低SpO2值在85％-90％之间或小于85％的病例数均多于其他组（P〈0．05），Ⅰ、Ⅱ组术中舌根后坠、术后恶心、呕吐发生率高于Ⅲ和Ⅳ组，Ⅳ组苏醒期兴奋躁动的发生率高于其他各组。麻醉效果达优者以Ⅳ组最少。术后下腹痛VAS评分0～2分者Ⅲ组优于其他组。结论异丙酚复合氯诺昔康用于老年患者妇科门诊短小手术的麻醉中不但可获得较为满意的麻醉效果，而且药物不良反应少，对术后下腹痛也表现出更好的镇痛效果，是一种更为有效的配伍方法。     

氟比洛芬酯联合丙泊酚与芬太尼联合丙泊酚用于无痛人工流产术的比较

目的：探讨氟比洛芬酯对无痛人工流产术麻醉及其术后镇痛的效果及安全性。方法：100例要求行人工流产者随机均分为2组，观察组先静脉注射氟比洛芬酯50mg，10min后静脉注射丙泊酚2mg／kg；对照组先缓慢静脉注射芬太尼1μg／kg，10min后静脉注射丙泊酚2mg／kg。两组丙泊酚静注速率均为100mg／min。观察并纪录两组用药前、睫毛反射消失时、术中、术毕时的收缩压、心率、呼吸频率及血氧饱和度，手术时间，苏醒时间，丙泊酚总用药量。不良反应，术中麻醉效果，以及术毕清醒后1、5、15、30min视觉模拟评分（VAS）值。结果：受术者睫毛反射消失时，观察组收缩压显著高于对照组（P〈0．05）；睫毛反射消失时及术中呼吸频率及血氧饱和度观察组显著高于对照组（P〈0．05），术中麻醉效果评定为优、良、差的例数及术毕清醒后1、5、15、30min时下腹部疼痛的VAS值，两组比较差异无统计学意义。结论：在人工流产术中应用氟比洛芬酯联合丙泊酚具有良好的术中麻醉及术后镇痛效果，对呼吸及循环抑制较轻，是一种较为安全有效的配伍方法。     

罗哌卡因、芬太尼用于硬膜外分娩镇痛的效果和结局

目的:评价0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于分娩镇痛的效果与结局。方法:180例初产妇人工破膜后行硬膜外镇痛,先注入1.5%的利多卡因4m l试验剂量后,注入0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液15 m l。再根据病人的要求可给予补充剂量的上述混合液,每次8 m l。另160例初产妇作为对照组未接受镇痛。结果:两组间VAS疼痛分级差异有统计学意义,镇痛组第一产程活跃期明显比对照组,且催产素的使用率高于对照组,差异均有统计学意义。而两组间第二产程、器械助产率和剖宫产率、羊水胎粪污染率、Apgar评分、新生儿体重及产后出血量等差异均无统计学意义。结论:0.125%罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于病人分娩镇痛具有极好的镇痛效果,不影响母婴结局,不增加器械助产率和剖宫产率。     

腹腔镜下子宫肌瘤剔除术48例围手术期的护理

目的 探讨腹腔镜下子宫肌瘤剔除术的围手术期护理。方法 对48例子宫肌瘤患者进行术前指导、心理护理及充分的术前准备，术中密切配合，术后严密观察生命体征及细心的护理。结果 48例患者临床疗效良好，患者术前、术后心理状况健康，术后生命体征平稳，无并发症发生，均顺利出院。结论用腹腔镜行子宫肌瘤剔除术具有出血少，损伤轻、恢复快、切口美观的优点，腹腔镜下子宫肌瘤剔除术围手术期的周密护理是手术成功、患者顺利出院的重要保证。