小儿术后皮下自控镇痛的效果

目的比较皮下自控镇痛（PCSA）与静脉自控镇痛（PCIA）在小儿术后自控镇痛的安全性和有效性。方法全麻下行扁桃体切除术后患儿50例，随机均分为PCSA组和PCIA组。PC－SA组配方为芬太尼0．5mg，PCIA组配方为芬太尼0．3mg，两组均加甲氧氯普胺5mg，均以生理盐水稀释成100ml，背景剂量2ml／h，锁定时间15min，单次按压负荷量0．5ml，镇痛持续48h。观察患儿术后的镇痛效果，记录镇痛满意率、PCA总按压次数、PCA有效按压次数及并发症。结果PC－SA组与PCIA组满意率分别为88％（22／25例）和92％（23／25例），差异无统计学意义（P〉O．05）。但PCSA组恶心呕吐发生率（8％）低于PCIA组（20％）（P〈0．05）。两组均未见嗜睡、呼吸抑制病例。结论PCSA可安全有效地用于全麻患儿术后镇痛。

Efficacy of patient controlled subcutaneous analgesia in postoperative children

Objective To compare the safety and postoperative analgesia efficacy of patient- controlled subcutaneous analgesia （PCSA） with patient-controlled intravenous analgesia （PCIA） in children. Methods Fifty children after tonsillectomy under general anesthesia were randomly divided into PCSA group and PCIA group. The formulation was fentanyl 0.5 mg and metoclopramide 5 mg in PCSA group, while in PCIA pump it was fentanyl 0. 3 mg and metoclopramide 5 mg. All drugs were diluted to 100 ml with normal saline lasting 48 h in two groups, background dose 2 ml/h, loc- king time 15 min and bolus 0.5 ml/per time. Analgesic effect was observed after the operation. Sat- isfaction rate of analgesia, total PCA times, effective PCA times and the complications were recor- ded. Results The satisfaction rate of analgesia was 88% （22/25 cases） and 92% （23/25 cases） in the PCSA group and PCIA group respectively （P〉0.05）. But the incidences of nausea and vomiting in PCSA group （8%） were significantly lower than that in the group PCIA （20%） （P〈0. 05）. No case was found with drowsiness or respiratory depression in the two groups. Conclusion PCSA can be used safely and effectively in postoperative analgesia in children undergoing general anesthesia.