布比卡因与新斯的明联用对小儿尿道下裂术后镇痛效果的系统评价_《中国循证医学杂志》

作者：

兰蕴平 , 黄振华 ,  左云霞

四川大学华西医院麻醉科（成都 610041）;

关键词：

布比卡因新斯的明尿道下裂系统评价

DOI：

10.7507/1672-2531.20090119

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价新斯的明与布比卡因联用骶管阻滞对小儿尿道下裂术后镇痛的效果。
方法　检索Cochrane图书馆（2008年第2期）、MEDLINE（1966～2008）、EMbase（1980～2008）、中国生物医学文献光盘数据库（CBMdisc，1978～2008）、中文科技期刊全文数据库（1989～2008）及万方数据库，收集有关布比卡因与新斯的明联用骶管阻滞在小儿尿道下裂术后镇痛效果与单纯使用布比卡因比较的随机对照试验。由两名评价员独立评价文献，对符合入选标准的研究用RevMan 5.0.13进行Meta分析。
结果　共纳入3个研究，包括160例患者，其方法学质量均为偏倚风险不确定。Meta分析结果显示：布比卡因与1 µg/kg新斯的明联用进行骶管阻滞与单用布比卡因比较，其镇痛时间差异无统计学意义［WMD= 0.05，95%CI（– 6.76，6.86），P= 0.99］；而布比卡因与2 µg/ kg、3 µg/ k和4 µg/ kg新斯的明联用进行骶管阻滞与单用布比卡因比较，其镇痛时间更长，差异有均有统计学意义［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］。
结论　由于样本量较小、纳入研究方法学质量不高，布比卡因与新斯的明联用进行骶管阻滞延长小儿尿道下裂术后镇痛时间的作用尚不能完全肯定，加之新斯的明用量仍不明确，因此仍需更多大样本的随机双盲对照试验进一步评价。

引用本文： 兰蕴平,黄振华,左云霞. 布比卡因与新斯的明联用对小儿尿道下裂术后镇痛效果的系统评价. 中国循证医学杂志, 2009, 09(6): 670-673. doi: 10.7507/1672-2531.20090119 复制

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.	李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 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. 李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 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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《中国循证医学杂志》

布比卡因与新斯的明联用对小儿尿道下裂术后镇痛效果的系统评价

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《中国循证医学杂志》

布比卡因与新斯的明联用对小儿尿道下裂术后镇痛效果的系统评价

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