目的 观察罗哌卡因复合曲马多骶管阻滞与单独应用罗哌卡因、曲马多，对小儿尿道下裂成形术后镇痛时间、疼痛评分、镇痛次数、睡眠质量满意度和并发症的影响。探讨罗哌卡因复合曲马多和单独应用曲马多、罗哌卡因能否提供满意的术后镇痛。 方法 选取自2012年6月~2013年2月于我院行尿道下裂成形术的患儿66名，美国麻醉医师协会（ASA） 分级Ⅰ级，年龄1岁~6岁，采用完全随机设计的方法分为3组（每组22例）：0.2%罗哌卡因 1 ml/kg组（L 组）、0.2%罗哌卡因1 ml/kg+曲马多1.5 mg/kg组（LT组）、0.9%氯化钠1 ml/kg+曲马多1.5 mg/kg组（T组）。麻醉维持均采用骶管阻滞复合全凭七氟醚吸入全麻。观察并记录镇痛维持时间（骶管阻滞到术后第1次镇痛给药的时间），术毕患儿清醒1、2、4、6、12、24 h 三点疼痛评分，术后24 h镇痛次数，睡眠质量满意度评估，并发症等。 结果 镇痛时间比较，LT组（14.5±2.5） h比其他两组明显延长（P<0.05）。3组疼痛评分在2 h前差异无统计学意义，2 h到6 h T组与L组、LT组比较，差异有统计学意义（P<0.05）。T组与LT组、L组比较，术后24 h所需镇痛次数明显加（P<0.05）。术后寒战发生率L组为18%，而LT组、T组为0。3组患儿术毕清醒均未出现运动神经阻滞，呕吐次数也无明显增加。LT组100%的患儿父母对患儿术后24 h睡眠质量满意度为优和良。 结论 0.2%罗哌卡因1 ml/kg复合曲马多1.5 mg/kg骶管阻滞用于6岁以下小儿尿道下裂成形术后镇痛是安全、有效的，可有效镇痛（14.5±2.5） h，并发症少且能有效减少术后寒战的发生。
Ｏｂｊｅｃｔｉｖｅ The aim of this study was to determine whether the caudal block with tramadol and ropivacaine combination provides better analgesia in respect of analgesia time， pain scores， total analgesic doses and side effects， compared with ropivacaine or tramadol alone. Methods Sixty-six ASA Ⅰ boys， aged 1 y-6 y old， underwent hypospadias surgery in our hospital from June of 2012 to February of 2013 were involved in this study. The boys were allocated randomly to three groups. Children in group L received 0.2% ropivacaine 1 ml/kg， group LT received an identical local anesthetic dose mixed with tramadol 1.5 mg/kg and 0.2% ropivacaine 1 ml/kg， and group T received caudal tramadol 1.5 mg/kg in 0.9% sodium chloride in the same total volume（1 ml/kg）. General anesthesia were induced and maintained with sevofurane. Duration of analgesia （time between caudal injection and first administration of analgesic） and requirement of additional analgesics were noted. Pain assessments were made 1，2，4，6，12 h and 24 h after recovery from anesthesia with reference to a three-point scale. Complications and parents' satisfaction with the procedure were recorded. Results Analgesia time （time between caudal injection and first administration of analgesic） in group LT （14.5±2.5） h was signicantly longer than in the other two groups （P<0.05）. Pain scores were similar in the three groups in the first two hours， and was signicantly higher in group T than groups L and LT both at 2， 4 h and 6 h after operation（P<0.05）. In group T， more patients required additional analgesia after surgery than in the other two groups（P<0.05）. Only patients in group L （18%） shivered after operation. No signs of motor block were observed after the first postoperative hour in any of the patients. The incidence of emesis was not statistically different between groups. Furthermore， 100% parents in group LT were evaluated with excellent and good sleep quality. Conclusions Caudal block with 0.2% ropivacaine （1 ml/kg） and tramadol （1.5 mg/kg） combinationis safe and effective for postoperative analgesia in pediatric hypospadias surgery， and it can significantly reduce the incidence of postoperative shivering.
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