Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children
Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children
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DOI：
10.1046/j.1460-9592.2000.00447.x
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发表时间：
2000-03-01
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影响因子：
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通讯作者：
Sweeney, DM
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作者：
Gunter, JB;McAuliffe, J;Sweeney, DM
我们研究了硬膜外注射布托啡诺预防或缓解儿童硬膜外注射吗啡引起的瘙痒的有效性。46名儿童随机接受硬膜外吗啡(M)或硬膜外吗啡加布托啡诺(B)用于术后镇痛。他们接受布比卡因加M 50微克·公斤(-1)或相同剂量的M加B 10微克·公斤(-1)。术后以0.3mL.kg(-1)·h(-1)的速率持续输注0.1%布比卡因加M20mg.ml(-1)或M20mg.ml(-1)+B4mg.ml(-1)。硬膜外输液期间每4h记录一次疼痛评分和瘙痒评分。瘙痒评分=2的受试者接受苯海拉明0.5 mg·kg(-1)静脉注射。M组(M组)切换到M+B组，而M+B组(B组)切换到氢吗啡酮(H)4微克·毫升(-1)。两组首次瘙痒发生率无差异(M组11/18，B组13/28)。M组在转至M+B后无因持续瘙痒而需二次更换硬膜外输液，B组13例中有5例在转至H后仍有瘙痒，需要二次更换硬膜外输液或其他镇痛方法(P=0.038)。在更换硬膜外输液后24 h内，M Delta组(由M改为M+B)和B Delta组(由M+B改为H；P=0.012)中位数瘙痒评分分别为0和1。两组前24 h镇静评分中位数均为1，但B组镇静评分为2的发生率高于M组(28%比12.3%；P=0.021)。B 10µg·kg(-1)不能有效预防儿童硬膜外注射M 50µg·kg(-1)引起的瘙痒。B 1.2 mU·kg(-1)·h(-1)可有效缓解持续硬膜外输注M6 mU·kg(-1)·h(-1)引起的瘙痒。
We examined the efficacy of epidural butorphanol to either prevent or relieve pruritus associated with epidural morphine infusion in children. Forty-six children were randomized to receive either epidural morphine (M) or epidural M with butorphanol (B) for postoperative analgesia. They received bupivacaine and either M 50 mu g.kg(-1) or the same dose of M plus B 10 mu g.kg(-1). Following surgery, a continuous infusion of 0.1% bupivacaine with either M 20 mu g.ml(-1) or M 20 mu g.ml(-1) + B 4 mu g.ml(-1) was given at a rate of 0.3 ml.kg(-1).h(-1). Pain scores and pruritus scores were recorded every 4 h during epidural infusion. Subjects with a pruritus score=2 received diphenhydramine 0.5 mg.kg(-1) i.v. and were switched to an alternate epidural infusion; subjects receiving M (group M) were switched to M+B while subjects receiving M+B (group B) were switched to hydromorphone (H) 4 mu g.ml(-1). There was no difference in the initial incidence of pruritus (group M 11/18; group B 13/28). No subject in group M required a second change of epidural infusion because of continued pruritus after being switched to M+B; five of 13 subjects in group B continued to experience pruritus after being switched to H and required a second change of epidural infusion or an alternate analgesic modality (P=0.038). The median pruritus score in the first 24 h after changing epidural infusions was 0 in subjects in group M Delta (changed from M to M+B) and 1 in subjects in group B Delta (changed from M+B to H; P=0.012). While the median sedation score in the first 24 h was 1 in both groups, there was a greater incidence of sedation scores of 2 in group B than group M (28% vs 12.3%; P=0.021). B 10 mu g.kg(-1) was not effective in preventing pruritus associated with bolus epidural administration of M 50 mu g.kg(-1) in children. B 1.2 mu g.kg(-1).h(-1) was effective in relieving pruritus associated with continuous epidural infusion of M 6 mu g.kg(-1).h(-1).