观察1~3岁患儿骶管阻滞术后应用不同浓度罗哌卡因进行术后镇痛的临床效果。

纳入对象为2007年在四川大学华西医院择期行腹股沟区手术的80例1~3岁患儿。将其随机分为四组，吸人诱导下用静脉留置针行骶管穿刺，并留置套针于骶管腔，固定于患儿骶尾部，先注入1%利多卡因1 mL/kg至骶管腔，1 h后再注入不同药液(A, B, C组分别注入0. 075%,0.100%,0.125%罗哌卡因，D组注人生理盐水)1 mL/kg(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，取得受试对象的知情同意，并与试验患儿监护人签署临床研究知情同意书)。

A，B，C和D组患儿术后镇痛持续时间分别为的5. 13 h(95 %CI 3. 90 h~6. 36 h), 7. 20 h(95 %CI 6.46 h~7. 94 h), 7. 65 h(95 %CI 7.25 h~8. 05 h)，3. 78 h(95%CI 2.45 h~5. 10 h)。四组患儿术后镇痛持续时间总体比较，差异有显著意义(P<0. 01)；B组和C组比较，差异无显著意义(P>0. 05)；A组和D组比较，差异无显著意义(P>0. 05)。A，B，C和D组患儿术后24 h内需要镇痛处理的病例数分别为11例、4例、3例和14例。

0.100%罗哌卡因1 mL/kg骶管阻滞可为1~3岁下腹壁手术患儿提供满意的术后早期镇痛。

To evaluate dose range on analgesic effect on ropivacaine in pediatric caudal anesthesia.

Eighty American Society of Anesthesiologist(ASA)physical status I children, aged 1 ~3 years, were admitted in West China Hospital, Sichuan University in 2007. They were randomly divided into four groups according to the varied ropivacaine concentration. After the sevoflurane inhalation induction, caudal injection was performed by a fixed catheter. As the basic anesthesia, 1 % lidocaine(1 mL/kg)was infused. One hour later, ropivacaine was given at different concentrations(1 mL/kg)to the group A(0. 075%), the group B(0. 100%), the group C(0. 125%). The group D children were the control group with saline solution(1 mL/kg). Informed consent was obtained from all participants. The major outcomes, like the analgesia duration and the numbers needed to treat were recorded after operation. Additional analgesia in the following 24 h was assessed by an independent expert of the Children and Infants Postoperative Pain Scale(CHIPPS)on the ward, and would be carried out once the Children and Infants Postoperative Pain Scale scores higher than or equal to four. Improved Bromage score was used to evaluate the lower limb motor blockade. The postoperative analgesia duration among different groups were calculated by Kanplan-Meimer survival analysis with the statistical inference at 0. 05.

Four groups had no significant difference with respect to the patient age, height, weight and surgical procedures. The postoperative analgesia duration of A, B, C and D groups were 5. 13 h(95%CI3. 90 h~6. 36 h), 7. 20 h(95 %CI 6. 46 h~7. 94 h), 7. 65 h(95%CI7. 25 h~8. 05 h)and 3. 78 h(95 %CI 2.45 h~5. 10 h), respectively. There was a significant difference among four groups(P<0. 01)and no difference between the group B and the group C(P>0. 05). Cases for additional analgesia were 11, 4, 3 and 14 in four groups.

Caudal ropivacaine 0. 100% can provide satisfactory postoperative analgesia for children undergoing elective sub-umbilical surgery at 1~3 years old.