SACROEPIDURAL ANALGESIA FOR POST-OPERATIVE PAIN RELIEF IN CHILDREN

For evaluation of the practicality of epidural analgesia for alleviation of post-operative pain, 66 class I or II patients with age ranging from 6 months to 12 years undergoing elective surgical procedures below the lower abdomen were enrolled study during the period from January to April 1989. Before termination of general anesthesia a single dose of 0.25 % bupivacaine, respectively at 0.25 mL / kg ( Ideal body weight), 0.5 mL/kg, 0.75 mL/kg, 1.0 mL/kg and 1.25 mL/kg was given sacroepidurally to 5 groups of patients. Our results showed that for surgery below the lower abdomen a dose at 1.0 mL/kg was sufficient to suffice the need for relief of post-operative pain. At this dosage it achieved a neural block up to T8-T6 and provided with an analgesia that could last 6.0±2.1 hours. During the entire course there were no untoward effects such as hypotension, bradycardia, vomiting and shivering to come about. Therefore, sacroepidural analgesia with 0.25 % bupivacaine at fitting single dose is safe and feasible in children as far as relief of post-operative pain for procedures below the lower abdomen is concerned.

關鍵字

Sacral epidural analgesia ； Post-operative pain control ； Bupivacaine

並列摘要

經由硬脊膜外腔，施予局部麻醉劑，對於成人是種普通且很好的麻醉及術後止痛方式；但對於小孩而言，卻較難施行，尤其是在十歲以下者。因此，關於這方面的研究及報告很少。我們選擇六十六位ASA I或Ⅱ，年齡在六個月到十二歲之間的小病人，於手術結束，病人尚未清醒時，施予薦椎硬膜外神經阻斷術（Sacral in-tervertebral epidural block），做爲手術後之止痛方法。病人採側臥、雙腿曲起，以19G Touhy針，在S2-3或S1-2位置下針。於空氣阻力消失、回抽没問題後，注入單一劑量之0.25％Bupivacaine（0.25 mL / kg理想體重，n = 4; 0.5 mL/kg理想體重，n = 9; 0.75 mL / kg理想體重，n = 24; 1.0 mL / kg理想體重，n = 23; 1.25 mL / kg理想體重，n = 6）。記下針頭與皮膚交接處，拔出針頭，並測量皮膚到硬脊膜外腔之深度。病人平躺三十分鐘後，讓不知情之護士用拇指及食指搯病人，觀察其疼痛反應來測試其神經阻斷之高度。對於下腹部以下之手術而言，1.0 mL / kg理想體重之0.25％Bupivacaine是最適合的劑量，整個過程並無諸如血壓降低、心跳變慢、發抖或嘔吐等副作用發生。所以，對於兒童手術而言，薦椎硬膜外神經阻斷術是一種可行的術後止痛法。

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SACROEPIDURAL ANALGESIA FOR POST-OPERATIVE PAIN RELIEF IN CHILDREN

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