右美托咪定对小儿罗哌卡因骶管阻滞效应的影响
摘要
目的研究右美托咪定对小儿骶管阻滞效应的影响。
方法选择60例1-6岁(ASA I)拟行腹股沟斜疝或鞘膜积液手术的患儿,随机分为两组(n=30)：R组骶管注入0.25%罗哌卡因lml/kg;RD组骶管注入0.25%罗哌卡因lml/kg+右美托咪定1μ g/kg。监测术中心率(HR)、呼吸(RR)、血压(BP)和脉搏氧饱和度(SpO2),记录骶管阻滞起效时间；患儿苏醒时间；镇痛药应用时间,采用Ramsay评分判定患儿苏醒和躁动,用FLACC量表评估患儿术后疼痛。
结果两组患儿月龄、体重、手术时间,阻滞起效时间无显著差异。与R组比较RD组苏醒时间延长,苏醒后躁动减少,镇痛药应用减少,镇痛时间延长(P<0.05)。
结论1u g/kg右美托咪定可增强小儿罗哌卡因骶管阻滞的效果。
Objective To investigate the influence of dexmedetomidine on the caudal block with ropivacaine in children.
Methods60patients suffering from indirect inguinal hernia or hydrocele of tunica vaginalis and aged1-6years were enrolled in our study. They were divided into two groups randomly to receive0.25%ropivacaine lmg/kg (group R) and0.25%ropivacaine lmg/kg and dexmedetomidine1μg/kg (group RD). The intra-operative heart rate(HR), respiratory rate(RR), tidal volume(TV), blood pressure(BP) and SpO2were normally monitored. The time of the onset of caudal block, the recovery of consciousness and the administration of analgesics were recorded. We select the Ramsay score to estimate the recovery from anesthesia and post-operative agitation and the FLACC Pain Assessment Tool to assess post-operative pain.
Results The age, weight, duration of operation and the onset of caudal block were comparable (p>0.05). Group RD displayed The recovery time were increased, post-operative agitation and the overall dose of analgesics of group RD were reduced in comparison with group R, while group RD displayed a markedly prolonged antalgic duration(p<0.05).
Conclusions Dexmedetomidine (1μg/kg) can enhance the effect of ropivacaine for the caudal block in children.
方法选择60例1-6岁(ASA I)拟行腹股沟斜疝或鞘膜积液手术的患儿,随机分为两组(n=30)：R组骶管注入0.25%罗哌卡因lml/kg;RD组骶管注入0.25%罗哌卡因lml/kg+右美托咪定1μ g/kg。监测术中心率(HR)、呼吸(RR)、血压(BP)和脉搏氧饱和度(SpO2),记录骶管阻滞起效时间；患儿苏醒时间；镇痛药应用时间,采用Ramsay评分判定患儿苏醒和躁动,用FLACC量表评估患儿术后疼痛。
结果两组患儿月龄、体重、手术时间,阻滞起效时间无显著差异。与R组比较RD组苏醒时间延长,苏醒后躁动减少,镇痛药应用减少,镇痛时间延长(P<0.05)。
结论1u g/kg右美托咪定可增强小儿罗哌卡因骶管阻滞的效果。
Objective To investigate the influence of dexmedetomidine on the caudal block with ropivacaine in children.
Methods60patients suffering from indirect inguinal hernia or hydrocele of tunica vaginalis and aged1-6years were enrolled in our study. They were divided into two groups randomly to receive0.25%ropivacaine lmg/kg (group R) and0.25%ropivacaine lmg/kg and dexmedetomidine1μg/kg (group RD). The intra-operative heart rate(HR), respiratory rate(RR), tidal volume(TV), blood pressure(BP) and SpO2were normally monitored. The time of the onset of caudal block, the recovery of consciousness and the administration of analgesics were recorded. We select the Ramsay score to estimate the recovery from anesthesia and post-operative agitation and the FLACC Pain Assessment Tool to assess post-operative pain.
Results The age, weight, duration of operation and the onset of caudal block were comparable (p>0.05). Group RD displayed The recovery time were increased, post-operative agitation and the overall dose of analgesics of group RD were reduced in comparison with group R, while group RD displayed a markedly prolonged antalgic duration(p<0.05).
Conclusions Dexmedetomidine (1μg/kg) can enhance the effect of ropivacaine for the caudal block in children.
引文
1 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anesthesia,1999,54:146-165.
2 Martin E, Ramsay G, Mantz J, et al. The Role of the a 2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit. J Intensive Care Med,2003,18:29-41.
3 Maroof M, Jaine D, Khan RM, Dogra S, Maroof S. Epidural dexmedetomidine provides post-operative analgesia. Anaesth Analg,2004,98:S174.
4 Gogia S, Maroof M, Verma V, Jain S, McGee JP, Khan RM. Use of epidural dexmedetomidine in patients undergoing post traumatic lower limb orthopedic surgery. Anesth Analg, 2007,104:S186.
5 Deng XM, Xiao WJ, Tang GZ, Luo MP, Xu KL. The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children. Anesth Analg,2002,94:1465-1468.
6 Birbicer H, Doruk N, Cinel I, Atici S, Avlan D, Bilgin E, et al. Could adding magnesium as adjuvant to ropivacaine in caudal anaesthesia improve postoperative pain control. Pediatr Surg Int,2007,23:195-198.
7 Ray M, Mondal SK, Biswas A. Caudal analgesia in paediatric patients:Comparison between Bupivacaine and Ropivacaine. Indian J Anaesth,2003,47:275-278.
8 Scheinin M, Pihlavisto M. Molecular pharmacology of alpha2-adrenoceptor agonists. Bailliere's Clin Anaesth,2000,14:247-260.
9 Willems EW, Valdivia LF, Villalon CM, et al. Possible role of alpha-adrenoceptor subtypes in acute migraine therapy. Cephalalgia2003,23(4):245-257。
10 Mackinnon AC, Spedding M, Bmwn CM, et al. a 2-adrenoceptors:more subtype but fewer function differences. Trend Pharmacol Sci,1994,15:119-123.
11 Lakhlani PP, Macmillan LB, Guo Tz, et al. Substitution of a mutant a 2A-adrenergic receptor via'hit and ran'gene targeting reveals the role of this subtype in sedative, analgesic and anesthetic-sparing responses in vivo. Proc Natl Acad Sci USA,1997,94: 9950-9955.
12 Nicoletta Galeotti, Alessandro Bartolini, Carla Ghelardini. Alpha-2 agonist-induced memory impairment is mediated by the alpha-2A-adrenoceptor subtype. Behavioural Brain Research,2004,153:409-417.
13 Link RE, Desai K, Hein L, et al. Cardiovasular regulation in mice lacking a 2-adrenergic subtype b and c. Science,1996,273:803-805.
14 Sallinen J, Haapalinna A, Viitamaa T, et al. Adrenergic a 2C receptors modulate the acoustic startle reflex, prepulse inhibition and aggression in mice. J Neurosci,1998,18:3035-3042.
15 Calzada BC, De Artinano AA. [alpha] 2-adrenoceptor subtypes. Pharmacol Res 2001,44:195-208.
16 Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand.2009,53:251-256.
17 El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth,2009,103:268-274.
18李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展.中国临床药理学杂志,2007,23(6)：466-471.
19 Petroz GC, Sikich N, James M, van Dyk H, Shafer SL, Schily M, et al. A phase I, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology,2006,105:1098-1110.
20 Koroglu A, Teksan H, Sagir 0, Yucel A, Toprak HI, Ersoy OM. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg,2006,103:63-67.
21 Lerman J. Anxiolysis-by the parent or for the parent?. Anesthesiology,2000,92: 939-946.
1 许峰.疼痛,一个尚未引起儿科医师足够重视的问题.中华儿科杂志,2005,12：42.
2 American Academy of Pediatrics Committee on psychosocial aspect of child and family health;American pain society, task force on pain in infants, children and adolescents The assessment and management of acute pain in infants, children, and adolescents. Pediatric,2001,108(3):793-797.
3 罗爱伦,张亚军.要重视小儿术后疼痛管理.中华麻醉学杂志,1999,19(3)：133.
4 王大柱.小儿围术期疼痛治疗.中华麻醉学杂志,2000,20(8)：510-512.
5 傅小云,常业恬,贺达仁.加强小儿围术期疼痛管理.医学与哲学,2007,28(10)：80.
6 张秉均.小儿麻醉进展.中华麻醉学杂志,1998,18(4)：253.
7 Mitchell A, Boss BJ. Adverse effects of pain on the nervous systems newborns and young children:a review of the literature. J Neurosci Nurs,2002,34 (5):228.
8 王锦琰.重视儿童的疼痛.中国疼痛医学杂志,2006,12(2)：66.
9 邬娇,郭曲练.儿童术后镇痛的现状及进展.实用疼痛学杂志,2007,3(5)：373.
10王大柱.小儿围术期疼痛治疗[J].中华麻醉学杂志,2000,20：510.
11 Shobha M, Terri VL, Constance B, et al. The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia,2006,16:258.
12张菊英,周瑞芳,叶家薇.五指法在疼痛评估中的应用.中华护理杂志,2005,40(6)：409.
13 MCGRATH P, GILLESP IE J. Pain assessment in children and adolescents. TURK D C, MELZACK R. Handbook of pain assessment. New York,Guil2 ford Press,2001,97-117.
14王建光,李雪梅,连庆泉.小儿术后镇痛进展.实用儿科临床杂志,2005,20(5)：478.
15 Monitto CL, Greenberg RS, Kost2Byerly S, et al. The safety and efficacy of parent2/nurse2controlled analgesia in patients less than six years of age. Anesth Analg,2000,91(3):573-579.
16 Walder B, SchaferM, Henzi I, et al. Efficacy and safety of patient-controlled op ioid analgesia for acute postoperative pain:A quantitative systematic review. Acta Anaesthesiol Scand,2001,45 (7):795-804.
17 Philip BK, Reese PR, Burch SP, The economic impact of opioids on postoperative pain management. J Clin Anesth,2002,14(5):354-364.
18 VitaleMG, Choe JC, HwangMW, et al. Use of ketorolac tromethaminein children undergoing scoliosis surgery. Ananalysis of complications. Spine J,2003,3 (1) 55-62.
19 Kokki H. Non-steroidal anti-inflammatory for postoperative pain:a focus on children. Pediatric Drugs,2003,5(2):103-123.
20 Birmingham PK, Tobin MJ, Henthorn TK, et al.24hour pharmaco-kinetics of rectal acetaminophen in children:An old drugwith new recommendations. Anesthesiology, 1997,87(2):244-252.
21 Ivani G, Tonetti F. Postoperative analgesia in infants and children:new developments. Minerva Anestesiol,2004,70(5):399-403.
22马长松,周洁贤.连续硬膜外与静脉麻醉对小儿术后镇痛的效果比较.中国妇幼保健,2005, 20(17)：2202.
23 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anesthesia,1999,54:146-165.
24 KanaziGE, Aou adMT, Jabbou r- Khoury SI, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiologica Scandinavica,2006,50:222-227.
25 Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand.2009,53:251-256.
26 El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth,2009,103:268-274.
2 Martin E, Ramsay G, Mantz J, et al. The Role of the a 2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit. J Intensive Care Med,2003,18:29-41.
3 Maroof M, Jaine D, Khan RM, Dogra S, Maroof S. Epidural dexmedetomidine provides post-operative analgesia. Anaesth Analg,2004,98:S174.
4 Gogia S, Maroof M, Verma V, Jain S, McGee JP, Khan RM. Use of epidural dexmedetomidine in patients undergoing post traumatic lower limb orthopedic surgery. Anesth Analg, 2007,104:S186.
5 Deng XM, Xiao WJ, Tang GZ, Luo MP, Xu KL. The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children. Anesth Analg,2002,94:1465-1468.
6 Birbicer H, Doruk N, Cinel I, Atici S, Avlan D, Bilgin E, et al. Could adding magnesium as adjuvant to ropivacaine in caudal anaesthesia improve postoperative pain control. Pediatr Surg Int,2007,23:195-198.
7 Ray M, Mondal SK, Biswas A. Caudal analgesia in paediatric patients:Comparison between Bupivacaine and Ropivacaine. Indian J Anaesth,2003,47:275-278.
8 Scheinin M, Pihlavisto M. Molecular pharmacology of alpha2-adrenoceptor agonists. Bailliere's Clin Anaesth,2000,14:247-260.
9 Willems EW, Valdivia LF, Villalon CM, et al. Possible role of alpha-adrenoceptor subtypes in acute migraine therapy. Cephalalgia2003,23(4):245-257。
10 Mackinnon AC, Spedding M, Bmwn CM, et al. a 2-adrenoceptors:more subtype but fewer function differences. Trend Pharmacol Sci,1994,15:119-123.
11 Lakhlani PP, Macmillan LB, Guo Tz, et al. Substitution of a mutant a 2A-adrenergic receptor via'hit and ran'gene targeting reveals the role of this subtype in sedative, analgesic and anesthetic-sparing responses in vivo. Proc Natl Acad Sci USA,1997,94: 9950-9955.
12 Nicoletta Galeotti, Alessandro Bartolini, Carla Ghelardini. Alpha-2 agonist-induced memory impairment is mediated by the alpha-2A-adrenoceptor subtype. Behavioural Brain Research,2004,153:409-417.
13 Link RE, Desai K, Hein L, et al. Cardiovasular regulation in mice lacking a 2-adrenergic subtype b and c. Science,1996,273:803-805.
14 Sallinen J, Haapalinna A, Viitamaa T, et al. Adrenergic a 2C receptors modulate the acoustic startle reflex, prepulse inhibition and aggression in mice. J Neurosci,1998,18:3035-3042.
15 Calzada BC, De Artinano AA. [alpha] 2-adrenoceptor subtypes. Pharmacol Res 2001,44:195-208.
16 Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand.2009,53:251-256.
17 El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth,2009,103:268-274.
18李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展.中国临床药理学杂志,2007,23(6)：466-471.
19 Petroz GC, Sikich N, James M, van Dyk H, Shafer SL, Schily M, et al. A phase I, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology,2006,105:1098-1110.
20 Koroglu A, Teksan H, Sagir 0, Yucel A, Toprak HI, Ersoy OM. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg,2006,103:63-67.
21 Lerman J. Anxiolysis-by the parent or for the parent?. Anesthesiology,2000,92: 939-946.
1 许峰.疼痛,一个尚未引起儿科医师足够重视的问题.中华儿科杂志,2005,12：42.
2 American Academy of Pediatrics Committee on psychosocial aspect of child and family health;American pain society, task force on pain in infants, children and adolescents The assessment and management of acute pain in infants, children, and adolescents. Pediatric,2001,108(3):793-797.
3 罗爱伦,张亚军.要重视小儿术后疼痛管理.中华麻醉学杂志,1999,19(3)：133.
4 王大柱.小儿围术期疼痛治疗.中华麻醉学杂志,2000,20(8)：510-512.
5 傅小云,常业恬,贺达仁.加强小儿围术期疼痛管理.医学与哲学,2007,28(10)：80.
6 张秉均.小儿麻醉进展.中华麻醉学杂志,1998,18(4)：253.
7 Mitchell A, Boss BJ. Adverse effects of pain on the nervous systems newborns and young children:a review of the literature. J Neurosci Nurs,2002,34 (5):228.
8 王锦琰.重视儿童的疼痛.中国疼痛医学杂志,2006,12(2)：66.
9 邬娇,郭曲练.儿童术后镇痛的现状及进展.实用疼痛学杂志,2007,3(5)：373.
10王大柱.小儿围术期疼痛治疗[J].中华麻醉学杂志,2000,20：510.
11 Shobha M, Terri VL, Constance B, et al. The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia,2006,16:258.
12张菊英,周瑞芳,叶家薇.五指法在疼痛评估中的应用.中华护理杂志,2005,40(6)：409.
13 MCGRATH P, GILLESP IE J. Pain assessment in children and adolescents. TURK D C, MELZACK R. Handbook of pain assessment. New York,Guil2 ford Press,2001,97-117.
14王建光,李雪梅,连庆泉.小儿术后镇痛进展.实用儿科临床杂志,2005,20(5)：478.
15 Monitto CL, Greenberg RS, Kost2Byerly S, et al. The safety and efficacy of parent2/nurse2controlled analgesia in patients less than six years of age. Anesth Analg,2000,91(3):573-579.
16 Walder B, SchaferM, Henzi I, et al. Efficacy and safety of patient-controlled op ioid analgesia for acute postoperative pain:A quantitative systematic review. Acta Anaesthesiol Scand,2001,45 (7):795-804.
17 Philip BK, Reese PR, Burch SP, The economic impact of opioids on postoperative pain management. J Clin Anesth,2002,14(5):354-364.
18 VitaleMG, Choe JC, HwangMW, et al. Use of ketorolac tromethaminein children undergoing scoliosis surgery. Ananalysis of complications. Spine J,2003,3 (1) 55-62.
19 Kokki H. Non-steroidal anti-inflammatory for postoperative pain:a focus on children. Pediatric Drugs,2003,5(2):103-123.
20 Birmingham PK, Tobin MJ, Henthorn TK, et al.24hour pharmaco-kinetics of rectal acetaminophen in children:An old drugwith new recommendations. Anesthesiology, 1997,87(2):244-252.
21 Ivani G, Tonetti F. Postoperative analgesia in infants and children:new developments. Minerva Anestesiol,2004,70(5):399-403.
22马长松,周洁贤.连续硬膜外与静脉麻醉对小儿术后镇痛的效果比较.中国妇幼保健,2005, 20(17)：2202.
23 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anesthesia,1999,54:146-165.
24 KanaziGE, Aou adMT, Jabbou r- Khoury SI, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiologica Scandinavica,2006,50:222-227.
25 Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand.2009,53:251-256.
26 El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth,2009,103:268-274.