Multimodal Analgesia Applied In Postoperative Analgesia Of Pediatric Lower Extremity Operation

Objective: Postoperative pain is sort of stress response caused by surgery operative wound,this manifests as some unpleasant experience in physical and psychological aspect.Always,it’s hard to evaluate the extent of pain since children aren’t able to describe the place,degree and nature of the it.Coupled with the analgesic pharmacy use limitation after operation,the postoperative- pain,the children feel,will be ignored badly with the consequence tremendous pain coming to them and affecting the follow-up recovery procedure.It was showed by researchs that the degree of pain and neuroendocrine responses of infants is three to five time more than adults.As a result,an effective analgesia is especially important for infants.Multimodal analgesia is a bran-new notion,it can product a perfect analgesia effect to ease the influence pain take in on the neuro system,immune system,endocrine system and maintain the the relative stability of internal environment via combining with some analgesic pharmacy or diversified analgesic method application with different mechanism of action and then act on different time and target in pain physiopathologic mechanism.As children’s organ development don’t mature,it’s proper to apply the Multimodal analgesia to decrease the rate of respiratory depression,nausea,vomit complication after operation.This experiment is panning to observed the feasibility of multimodal analgesia applied in postoperative analgesia of pediatric lower extremity operation and offer some reference about postoperative analgesic method in case.Methods: Select 20 undergoing low extremity surgery children patients,age:8~12years old,the rank of ASA isⅠorⅡ,but exclude the infants who have use the Monoamine oxidase inhibitors(MAOIs) and got spine malformation,hepatorenal dysfunction,coagulation dysfunction and shock or fat.Before the operation,visit all the children patients involved and get the corporation from them,telling them not drinking anything for 4 hours and not eating anything for 8 hours.Intramuscular inject 1mg/kg both dolantin and promethazine in all the patients 30 min before surgery starts.Conventional take in oxygen(2-4L/min) after entering the operateing room,and detect their mean arterial pressure,heart rate,pulse,respiratory,pulse oxygen saturation and electrocardiogram.Build venous channel,infuse sodium lactate Ringer’s injetion(6-8ml/kg/h),puncture on children patients’ lumbar spine 3-4 space with right lateral position,give them 2% lidocaine 2 ml after puncture successfully and observe the adverse effects include total spine anesthesia and local anesthetic intoxication,if there were no adverse effects,give them the mixture of 2% lidocaine(0.3ml/kg) and 0.75% bupivacaine(0.3ml/kg) containing 0.02% adrenergic,the total amount of the mixture be less than 20 ml.Mix the lidocaine and the bupivacaine with the volume ratio of 1:1 if the mixmum capacity be more than 20 ml,and then injecting the mixture of 20 ml into the epidural spase.Give the patiens Flurbiprofen Axetil Injection 0.5mg/kg when there just 15 min remained before the operation finished.When the operation is to finished,connect a patient-controlled analgesia(PCA) pumb(Flurbiprofen axetil injection 1 mg/kg+Fentanyl 8μg/kg+NS total to 100ml).Observe and record the children’s blood pressure,heart rate,pulse, respiration,pulse oxygen saturation and bleeding during an operation. The pain degree was estimated by visual analog scale score.0 point indicates painlessness,10 points indicates unbearable fierce ache,0~3 satisfation,4~6 analglesia not compeletly,7~10 is failure.Furthermore,record the occurrence rate of patiens’ nausea,vomit,pruritus,respiratory depression and uroschesis after operation.Results: Life sign was good in all children with intraoperative,VAS pain score in 48 hours of postoperative less than three score and postoperative pain relief is satisfied and safe.Postoperative nausea and vomit only 1case,rate of occurring was 5%,nausea,vomit,itchy skin,respiratory depression and uroschesis didn’t happen in other case.Conclusion:The analgesic effect of Flurbiprofen combined with Fentanyl is satisfied and safe in children lower extremity surgery,it can relieve the pain feeling of the children patients effectivily,and no obvious adverse reactions occurred.So,the method can safely be used in the postopretive analgesia of children’s lower limb surgery.