布比卡因與新斯的明聯用對小兒尿道下裂術后鎮痛效果的系統評價_《中國循證醫學雜志》

作者：

蘭蘊平 , 黃振華 ,  左云霞

四川大學華西醫院麻醉科（成都?610041）;

關鍵詞：

布比卡因新斯的明尿道下裂系統評價

DOI：

10.7507/1672-2531.20090119

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目的　系統評價新斯的明與布比卡因聯用骶管阻滯對小兒尿道下裂術后鎮痛的效果。
方法　檢索Cochrane圖書館（2008年第2期）、MEDLINE（1966～2008）、EMbase（1980～2008）、中國生物醫學文獻光盤數據庫（CBMdisc，1978～2008）、中文科技期刊全文數據庫（1989～2008）及萬方數據庫，收集有關布比卡因與新斯的明聯用骶管阻滯在小兒尿道下裂術后鎮痛效果與單純使用布比卡因比較的隨機對照試驗。由兩名評價員獨立評價文獻，對符合入選標準的研究用RevMan 5.0.13進行Meta分析。
結果　共納入3個研究，包括160例患者，其方法學質量均為偏倚風險不確定。Meta分析結果顯示：布比卡因與1 μg/kg新斯的明聯用進行骶管阻滯與單用布比卡因比較，其鎮痛時間差異無統計學意義［WMD= 0.05，95%CI（–?6.76，6.86），P= 0.99］；而布比卡因與2 μg/?kg、3 μg/?k和4 μg/?kg新斯的明聯用進行骶管阻滯與單用布比卡因比較，其鎮痛時間更長，差異有均有統計學意義［WMD= 12.79，95%CI（10.96，14.62），P lt; 0.000 01；WMD= 12.10，95% CI（–?6.76，6.86），P lt; 0.000 01；WMD= 11.90，95%CI（9.17，14.63），P lt; 0.000 01］。
結論　由于樣本量較小、納入研究方法學質量不高，布比卡因與新斯的明聯用進行骶管阻滯延長小兒尿道下裂術后鎮痛時間的作用尚不能完全肯定，加之新斯的明用量仍不明確，因此仍需更多大樣本的隨機雙盲對照試驗進一步評價。

引用本文： 蘭蘊平,黃振華,左云霞. 布比卡因與新斯的明聯用對小兒尿道下裂術后鎮痛效果的系統評價. 中國循證醫學雜志, 2009, 09(6): 670-673. doi: 10.7507/1672-2531.20090119 復制

1.	Dalens BJ. Regional anesthesia in children. Miller RD, Ed.. Anesthesia, 5th ed. Philadelphia: Churchill Livingstone, 2000. 1549-1585.
2.	Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesic produced by bupivacaine in children. Br J Anaesth, 1995, 75(6): 698-701.
3.	Wolf AR, Hughes D, Wade A, et al. Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine morphine mixture. Br J Anaesth, 1990, 64(4): 430-435.
4.	Senel AC, Akyol A, Dohman D, et al. Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric hernioraphy. Acta Anaesthesiol Scand, 2001, 45(6): 786-789.
5.	Lauretti GR, Reis MP, Prado WA, et al. Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty. Anesth Analg, 1996, 82(6): 1182-1187.
6.	Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine co administered with lidocaine for postoperative analgesia. Anesthesiology, 1999, 90(6): 1534-1538.
7.	Lauretti GR, Gomes JM, Reis MP, et al. Low doses of epidural ketamine or neostigmine, but not midazolam improves morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth, 1999, 11(8): 663-668.
8.	Iwamoto ET, Marion L. Characterization of the antinociception produced by intrathecally administered muscarinic agonists in rats. J Pharmacol Exp Ther, 1993, 266(1): 329-338.
9.	Yaksh TL, Dirksen R, Harty GJ. Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. Eur J Pharmacol, 1985, 117(1): 81-88.
10.	Turan A, Memis D, Basaran UN, et al. Caudal ropivacaine and neostigmine in pediatric surgery. Anesthesiology, 2003, 98(3): 719-722.
11.	Kumar P, Rudra A, Pan AK, et al. Caudal additives in pediatrics: A comparison among midazolam, ketamine and neostigmine coadministered with bupivacaine. Anesth Analg, 2005, 101(1): 69-73.
12.	李靜, 李幼平. 不斷完善與發展的Cochrane系統評價. 中國循證醫學雜志, 2008, 8(9): 742-743.
13.	Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesth Analg, 2002, 95(5): 1215-1218.
14.	Mahajan R, Grover VK, Chari P. Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children. Can J Anaesth, 2004, 51(7): 702-706.
15.	Batra YK, Arya VK, Mahajan R, et al. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anaesth, 2003, 13(6): 515-521.
16.	Naguib M, Yaksh TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with μ and α2 receptor systems. Anesthesiology, 1994, 80(6): 1338-1348.
17.	Roelants F, Rizzo M, Lavand’homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg, 2003, 96(4): 1161-1166.
18.	Lauretti GR, Hood DD, Eisenach JC, et al. A multi-center study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology, 1998, 89(4): 913-918.
19.	Gaitini LA, Somri M, Vaida SJ, et al. Does the addition of fentanyl to bupivacaine in caudal epidural block have an effect on plasma level of catecholamines in children? Anesth Analg, 2000, 90(5): 1029-1033.
20.	Krukowski JA, Hood DD, Eisenach JC, et al. Intrathecal neostigmine for postcesarean section analgesia: dose response. Anesth Analg, 1997, 84(6): 1269-1275.

1. Dalens BJ. Regional anesthesia in children. Miller RD, Ed.. Anesthesia, 5th ed. Philadelphia: Churchill Livingstone, 2000. 1549-1585.
2. Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesic produced by bupivacaine in children. Br J Anaesth, 1995, 75(6): 698-701.
3. Wolf AR, Hughes D, Wade A, et al. Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine morphine mixture. Br J Anaesth, 1990, 64(4): 430-435.
4. Senel AC, Akyol A, Dohman D, et al. Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric hernioraphy. Acta Anaesthesiol Scand, 2001, 45(6): 786-789.
5. Lauretti GR, Reis MP, Prado WA, et al. Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty. Anesth Analg, 1996, 82(6): 1182-1187.
6. Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine co administered with lidocaine for postoperative analgesia. Anesthesiology, 1999, 90(6): 1534-1538.
7. Lauretti GR, Gomes JM, Reis MP, et al. Low doses of epidural ketamine or neostigmine, but not midazolam improves morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth, 1999, 11(8): 663-668.
8. Iwamoto ET, Marion L. Characterization of the antinociception produced by intrathecally administered muscarinic agonists in rats. J Pharmacol Exp Ther, 1993, 266(1): 329-338.
9. Yaksh TL, Dirksen R, Harty GJ. Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. Eur J Pharmacol, 1985, 117(1): 81-88.
10. Turan A, Memis D, Basaran UN, et al. Caudal ropivacaine and neostigmine in pediatric surgery. Anesthesiology, 2003, 98(3): 719-722.
11. Kumar P, Rudra A, Pan AK, et al. Caudal additives in pediatrics: A comparison among midazolam, ketamine and neostigmine coadministered with bupivacaine. Anesth Analg, 2005, 101(1): 69-73.
12. 李靜, 李幼平. 不斷完善與發展的Cochrane系統評價. 中國循證醫學雜志, 2008, 8(9): 742-743.
13. Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesth Analg, 2002, 95(5): 1215-1218.
14. Mahajan R, Grover VK, Chari P. Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children. Can J Anaesth, 2004, 51(7): 702-706.
15. Batra YK, Arya VK, Mahajan R, et al. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anaesth, 2003, 13(6): 515-521.
16. Naguib M, Yaksh TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with μ and α2 receptor systems. Anesthesiology, 1994, 80(6): 1338-1348.
17. Roelants F, Rizzo M, Lavand’homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg, 2003, 96(4): 1161-1166.
18. Lauretti GR, Hood DD, Eisenach JC, et al. A multi-center study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology, 1998, 89(4): 913-918.
19. Gaitini LA, Somri M, Vaida SJ, et al. Does the addition of fentanyl to bupivacaine in caudal epidural block have an effect on plasma level of catecholamines in children? Anesth Analg, 2000, 90(5): 1029-1033.
20. Krukowski JA, Hood DD, Eisenach JC, et al. Intrathecal neostigmine for postcesarean section analgesia: dose response. Anesth Analg, 1997, 84(6): 1269-1275.

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布比卡因與新斯的明聯用對小兒尿道下裂術后鎮痛效果的系統評價

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《中國循證醫學雜志》

布比卡因與新斯的明聯用對小兒尿道下裂術后鎮痛效果的系統評價

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