探讨骶管阻滞对尿道下裂修复术患儿术后早期的镇痛效果。

选取2010年1至12月于四川大学华西医院接受尿道下裂修复术，并要求术后镇痛的38例患儿为研究对象。按照计算机录入顺序将其随机纳入研究组(采取全身麻醉联合骶管阻滞，n＝20)及对照组(采取全身麻醉，n＝18)。两组患儿于常规诱导下行气管插管术，采用2%～3%七氟醚(吸入)复合异丙酚[3 mg/(kg·h)静脉泵入维持麻醉。研究组采取单次骶管阻滞(局部麻醉药总剂量为0.8 mL/kg，包含1/3 1%利多卡因＋2/3 0.2%罗哌卡因，分开配制，先后注入骶管)；对照组加用瑞芬太尼[0.15 μg/(kg·min)，持续静脉泵入]。所有患者采用曲马多自控性镇痛法(PCA)。记录两组患儿术中生命体征和术后48 h内不同观察时间点的FLACC镇痛评分、镇静效果及不良反应，并进行统计学分析(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，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书)。

两组患儿一般情况及术中生命体征比较，差异无统计学意义(P>0.05)。FLACC评分<4分患儿所占比例及术后Ramsay镇静评分结果比较，在麻醉复苏室(PACU)内，研究组高于对照组，差异有统计学意义(P<0.05)，其他观察时间点比较，差异无统计学意义(P>0.05)。研究组术后躁动发生率明显低于对照组，差异也有统计学意义(P＝0.013)。两组术后不良反应发生率比较，差异无统计学意义(P>0.05)。

骶管阻滞可为接受尿道下裂修复术患儿术中、术后早期提供满意镇痛效果，并可减少术后镇痛药物的需要量，降低疼痛造成的术后烦躁发生率。

To observe the early postoperative analgesia effect of caudal block in children with hypospadias repair surgery.

From January to December 2010, 38 children who accepted hypospadias repair surgery and required postoperative analgesia were included in this study. They were randomly divided into research group(general anesthesia combined with caudal block, n=20) and control group(general anesthesia, n=18). The volume of local anesthetics was 0.8 mL/kg, of which 1/3 was 1% lidocaine and 2/3 was 0.2% ropivacaine, separately prepared and injected. In addition, continuous intravenous infusion of remifentanil were added to control group. During the operation, 2-3% sevoflurane inhalation and continuous intravenous infusion of propofol [3 mg/(kg·h)] were given for maintaining sedation in both groups, and all patients received tramadol patient controlled analgesia(PCA). The vital signs during operation, the FLACC pain score, sedation scale, and adverse reactions in 48 h after operation were recorded and assessed.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Hospital of Sichuan University.Informed consent was obtained from each parents.

There had no significant difference in general condition and vital signs during the operation between two groups(P>0.05). The component ratio of the children whose FLACC scores were less than 4 points and Ramsay sedation score in research group was obviously higher than that in control group in post anesthesia care unit(PACU) (P<0.05), but there was no significant difference in other observe time between two groups(P>0.05). The incidence of restlessness in research group was lower than that in control group (P<0.05). There was no significant difference in the incidence of nausea after operation between two groups(P>0.05).

Caudal block not only can provide satisfying early postoperative analgesia effect for children with hypospadias repair surgery, but also reduce analgesic requirements after operation.