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新生儿术后镇痛的临床进展

张弦 晏馥霞 陈凌宇 潘守东

张弦, 晏馥霞, 陈凌宇, 潘守东. 新生儿术后镇痛的临床进展[J]. 中华全科医学, 2023, 21(2): 292-297. doi: 10.16766/j.cnki.issn.1674-4152.002867
引用本文: 张弦, 晏馥霞, 陈凌宇, 潘守东. 新生儿术后镇痛的临床进展[J]. 中华全科医学, 2023, 21(2): 292-297. doi: 10.16766/j.cnki.issn.1674-4152.002867
ZHANG Xian, YAN Fu-xia, CHEN Ling-yu, PAN Shou-dong. Clinical progress of postoperative analgesia in neonates[J]. Chinese Journal of General Practice, 2023, 21(2): 292-297. doi: 10.16766/j.cnki.issn.1674-4152.002867
Citation: ZHANG Xian, YAN Fu-xia, CHEN Ling-yu, PAN Shou-dong. Clinical progress of postoperative analgesia in neonates[J]. Chinese Journal of General Practice, 2023, 21(2): 292-297. doi: 10.16766/j.cnki.issn.1674-4152.002867

新生儿术后镇痛的临床进展

doi: 10.16766/j.cnki.issn.1674-4152.002867
基金项目: 

首都临床特色应用研究基金资助项目 Z181100001718096

首都儿科研究所所级课题培育项目 PY-2020-08

详细信息
    通讯作者:

    潘守东, E-mail: adohn@163.com

  • 中图分类号: R726.1  R971.2

Clinical progress of postoperative analgesia in neonates

  • 摘要: 由于新生儿自身的发育生理和药代动力学特点,临床上针对这一人群的术后镇痛仍然受到一定程度的限制。新生儿尤其是早产儿仅被提供最少甚至不进行麻醉和镇痛。随着对生理学的深入研究,新生儿镇痛的重要性越来越受到临床医师的重视,术后镇痛也开始向按需的多模式镇痛方向发展。临床上针对新生儿出现各种各样的术后镇痛方式,但目前仍未有针对新生儿术后镇痛的药物和措施制定统一的指南,临床医师对新生儿术后镇痛的实施仍有顾虑。因此本文对已有的新生儿术后镇痛的方法进行总结,数据主要来自已发表的临床研究、病例报道和个案报道,对术后镇痛中使用的各类药物的具体用量、镇痛效果、不良反应和注意事项等进行统计,以便于临床医生应用时可以根据患儿的具体情况选择合适的镇痛方法。根据镇痛药物分类,包括阿片类药物如吗啡、芬太尼、舒芬太尼、曲马多,非阿片类药物如对乙酰氨基酚,酮咯酸,吡硝胺,局部麻醉药如布比卡因、罗哌卡因、氯普鲁卡因、利多卡因、混合局麻药,并对相同药物的不同给药方式和途径进行了总结和分析。非药物镇痛方法包括给予高糖溶液、非营养性吸吮、体位改变等措施。新生儿的特殊性使各类操作和效果评估的难度和风险均提高,各类镇痛方法仍需大量临床研究进行验证。

     

  • [1] SQUILLARO A, MAHDI E M, TRAN N, et al. Managing procedural pain in the neonate using an opioid-sparing approach[J]. Clin Ther, 2019, 41(9): 1701-1713. doi: 10.1016/j.clinthera.2019.07.014
    [2] MCPHERSON C, GRUNAU R E. Neonatal pain control and neurologic effects of anesthetics and sedatives in preterm infants[J]. Clin Perinatol, 2014, 41(1): 209-227. doi: 10.1016/j.clp.2013.10.002
    [3] DIJKA M V, BOUWMEESTER N J, DUIVENVOORDEN H J, et al. Efficacy of continuous versus intermittent morphine administration after major surgery in 0-3-year-old infants; a double-blind randomized controlled trial[J]. Pain, 2002, 98(3): 305-313. doi: 10.1016/S0304-3959(02)00031-3
    [4] BOUWMEESTER N J, ANAND K J, VAN DIJK M, et al. Hormonal and metabolic stress responses after major surgery in children aged 0-3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine[J]. Br J Anaesth, 2001, 87(3): 390-399. doi: 10.1093/bja/87.3.390
    [5] BOUWMEESTER N J, ANDERSON B J, TIBBOEL D, et al. Developmental pharmacokinetics of morphine and its metabolites in neonates, infants and young children[J]. Br J Anaesth, 2004, 92(2): 208-217. doi: 10.1093/bja/aeh042
    [6] 邵巧仪, 戴怡蘅, 王昕, 等. 围术期新生儿104例临床治疗方案回顾性分析[J]. 中国煤炭工业医学杂志, 2014, 17(7): 1111-1113. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY201407028.htm

    SHAO Q Y, DAI Y H, WANG X, et al. Retrospective analysis of clinical treatment of 104 neonates during perioperative period[J]. Chinese Journal of Coal Industry Medicine, 2014, 17(7): 1111-1113. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY201407028.htm
    [7] SUOMINEN P K, RAGG P G, MCKINLEY D F, et al. Intrathecal morphine provides effective and safe analgesia in children after cardiac surgery[J]. Acta Anaesthesiol Scand, 2004, 48(7): 875-882. doi: 10.1111/j.0001-5172.2004.00449.x
    [8] DE GRAAF J, VAN LINGEN R A, VALKENBURG A J, et al. Does neonatal morphine use affect neuropsychological outcomes at 8 to 9 years of age?[J]. Pain, 2013, 154(3): 449-458. doi: 10.1016/j.pain.2012.12.006
    [9] KOREN G, BUTT W, CHINYANGA H, et al. Postoperative morphine infusion in newborn infants: assessment of disposition characteristics and safety[J]. J Pediatr, 1985, 107(6): 963-967. doi: 10.1016/S0022-3476(85)80205-5
    [10] LYNN A, NESPECA M K, BRATTON S L, et al. Clearance of morphine in postoperative infants during intravenous infusion: The influence of age and surgery[J]. Anesth Analg, 1998, 86(5): 958-963. doi: 10.1213/00000539-199805000-00008
    [11] GUINSBURG R, KOPELMAN B I, ANAND K J, et al. Physiological, hormonal, and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates[J]. J Pediatr, 1998, 132(6): 954-959. doi: 10.1016/S0022-3476(98)70390-7
    [12] 王更富, 姚前进, 张江锋. 新生儿术后镇痛对炎症反应和术后感染的影响[J]. 江苏医药, 2013, 39(13): 1545-1547. doi: 10.19460/j.cnki.0253-3685.2013.13.019

    WANG G F, YAO Q J, ZHANG J F. Effects of postoperative analgesia on inflammatory reaction and infection in newborns[J]. Jiangsu Medical Journal, 2013, 39(13): 1545-1547. doi: 10.19460/j.cnki.0253-3685.2013.13.019
    [13] VAUGHN P R, TOWNSEND S F, THILO E H, et al. Comparison of continuous infusion of fentanyl to bolus dosing in neonates after surgery[J]. J Pediatr Surg, 1996, 31(12): 1616-1623. doi: 10.1016/S0022-3468(96)90033-0
    [14] ABIRAMALATHA T, MATHEW S K, MATHEW B S, et al. Continuous infusion versus intermittent bolus doses of fentanyl for analgesia and sedation in neonates: an open-label randomised controlled trial[J]. BMJ, 2019, 104(4): F433-F439.
    [15] GANESH A, ADZICK N S, FOSTE T, et al. Efficacy of addition of fentanyl to epidural bupivacaine on postoperative analgesia after thoracotomy for lung resection in infants[J]. Anesthesiology, 2008, 109(5): 890-894. doi: 10.1097/ALN.0b013e31818aa6cb
    [16] ENCINAS E, CALVO R, LUKAS J C, et al. A predictive pharmacokinetic/pharmacodynamic model of fentanyl for analgesia/sedation in neonates based on a semi-physiologic approach[J]. Paediatr Drugs, 2013, 15(3): 247-257. doi: 10.1007/s40272-013-0029-1
    [17] ANAND K J, HICKEY P R. Halothane-Morphine compared with high-dose Sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery[J]. N Engl J Med, 1992, 326(1): 1-9. doi: 10.1056/NEJM199201023260101
    [18] 方琼, 余雷, 向赟, 等. 术后舒芬太尼镇痛对开腹手术新生儿术后感染影响[J]. 中华医院感染学杂志, 2017, 27(2): 436-439. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201702053.htm

    FANG Q, YU L, XIANG Y, et al. Effect of postoperative analgesia with sufentanil on postoperative infections in neonates undergoing laparotomy[J]. Chinese Journal of Nosocomiology, 2017, 27(2): 436-439. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201702053.htm
    [19] ALENCAR A J C, SANUDO A, SAMPAIO V M R, et al. Efficacy of tramadol versus fentanyl for postoperative analgesia in neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2012, 97(1): F24-29. doi: 10.1136/adc.2010.203851
    [20] OLISCHAR M, DAVIDSON A J, LEE K J, et al. Effects of morphine and midazolam on sleep-wake cycling in amplitude-integrated electroencephalography in post-surgical neonates ≥ 32 weeks of gestational age[J]. Neonatology, 2012, 101(4): 293-300. doi: 10.1159/000334636
    [21] CEELIE I, DE WILDT S N, VAN DIJK M, et al. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial[J]. JAMA, 2013, 309(2): 149-154. doi: 10.1001/jama.2012.148050
    [22] PALMER G M, ATKINS M, ANDERSON B J, et al. I.V. acetaminophen pharmacokinetics in neonates after multiple doses[J]. Br J Anaesth, 2008, 101(4): 523-530. doi: 10.1093/bja/aen208
    [23] AGRAWAL S, FITZSIMONS J J, HORN V, et al. Intravenous paracetamol for postoperative analgesia in a 4-day-old term neonate[J]. Paediatr Anaesth, 2007, 17(1): 70-71. doi: 10.1111/j.1460-9592.2006.02004.x
    [24] HOWARD C R, HOWARD F M, WEITZMAN M L. Acetaminophen analgesia in neonatal circumcision: the effect on pain[J]. Pediatrics, 1994, 93(4): 641-646. doi: 10.1542/peds.93.4.641
    [25] BREMERICH D H, NEIDHART G, HEIMANN K, et al. Prophylactically-administered rectal acetaminophen does not reduce postoperative opioid requirements in infants and small children undergoing elective cleft palate repair[J]. Anesth Analg, 2001, 92(4): 907-912. doi: 10.1097/00000539-200104000-00020
    [26] PAPACCI P, DE FRANCISCI G, IACOBUCCI T, et al. Use of intravenous ketorolac in the neonate and premature babies[J]. Paediatr Anaesth, 2004, 14(6): 487-492. doi: 10.1111/j.1460-9592.2004.01250.x
    [27] GUPTA A, DAGGETT C, DRANT S, et al. Prospective randomized trial of ketorolac after congenital heart surgery[J]. J Cardiothorac Vasc Anesth, 2004, 18(4): 454-457. doi: 10.1053/j.jvca.2004.05.024
    [28] MULLER C, KREMER W, HARLFINGER S, et al. Pharmacokinetics of piritramide in newborns, infants and young children in intensive care units[J]. Eur J Pediatr, 2006, 165(4): 229-239. doi: 10.1007/s00431-005-0021-z
    [29] CASS L J, HOWARD R F. Respiratory complications due to inadequate analgesia following thoracotomy in a neonate[J]. Anaesthesia, 1994, 49(10): 879-880. doi: 10.1111/j.1365-2044.1994.tb04264.x
    [30] LEJUS C, SURBLED M, SCHWOERER D, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases[J]. Paediatr Anaesth, 2001, 11(3): 327-332. doi: 10.1046/j.1460-9592.2001.00659.x
    [31] KARMAKAR M K, BOOKER P D, FRANKS R, et al. Continuous extrapleural paravertebral infusion of bupivacaine for post-thoracotomy analgesia in young infants[J]. Br J Anaesth, 1996, 76(6): 811-815. doi: 10.1093/bja/76.6.811
    [32] CHEUNG S L, BOOKER P D, FRANKS R, et al. Serum concentrations of bupivacaine during prolonged continuous paravertebral infusion in young infants[J]. Br J Anaesth, 1997, 79(1): 9-13. doi: 10.1093/bja/79.1.9
    [33] ALTIPARMAK B, KORKMAZ TOKER M, UYSAL A I, et al. Erector spinae plane block for pain management of esophageal atresia in a preterm neonate[J]. J Clin Anesth, 2019, 56: 115-116. doi: 10.1016/j.jclinane.2019.01.039
    [34] BIELSKY A, EFRAT R, SURESH S. Postoperative analgesia in neonates after major abdominal surgery: ' TAP ' our way to success![J]. Paediatr Anaesth, 2009, 19(5): 541-542. doi: 10.1111/j.1460-9592.2009.02988.x
    [35] LEELANUKROM R, SURASERANIVONGSE S, BOONRUKWANICH V, et al. Effect of wound infiltration with bupivacaine on postoperative analgesia in neonates and infants undergoing major abdominal surgery: a pilot randomized controlled trial[J]. J Anesth, 2012, 26(4): 541-544. LEELANUKROM R, SURASERANIVONGSE S, BOONRUKWANICH V, et al. Effect of wound infiltration with bupivacaine on postoperative analgesia in neonates and infants undergoing major abdominal surgery: a pilot randomized controlled trial[J]. J Anesth, 2012, 26(4): 541-544. doi: 10.1007/s00540-012-1355-0
    [36] HOEHN T, JETZEK-ZADER M, BLOHM M, et al. Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant[J]. Paediatr Anaesth, 2007, 17(2): 176-179. doi: 10.1111/j.1460-9592.2006.02038.x
    [37] RAPP H J, MOLNÁR V, AUSTIN S, et al. Ropivacaine in neonates and infants: a population pharmacokinetic evaluation following single caudal block[J]. Paediatr Anaesth, 2004, 14(9): 724-732. doi: 10.1111/j.1460-9592.2004.01373.x
    [38] HERNANDEZ M A, VISOIU M. Postoperative pain management for tracheoesophageal fistula repair using transverse, in-plane, ultrasound guided paravertebral technique in a 2 kg neonate[J]. J Clin Anesth, 2018, 50: 57-58. doi: 10.1016/j.jclinane.2018.06.041
    [39] FREDRICKSON M J, SEAL P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery[J]. Anaesth Intensive Care, 2009, 37(3): 469-472. doi: 10.1177/0310057X0903700303
    [40] SCHALKWYK A S, FLAHERTY J, HESS D, et al. Erector spinae catheter for post-thoracotomy pain control in a premature neonate[J]. BMJ Case Reports, 2020, 13(9): e234480. DOI: 10.1136/bcr-2020-234480.
    [41] LEHR V T, CEPEDA E, FRATTARELLI D A C, et al. Lidocaine 4% cream compared with lidocaine 2.5% and prilocaine 2.5% or dorsal penile block for circumcision[J]. Am J Perinatol, 2005, 22(5): 231-237. doi: 10.1055/s-2005-871655
    [42] NAHUM Y, TENENBAUM A, ISAIAH W, et al. Effect of eutectic mixture of local anesthetics (EMLA) for pain relief during suprapubic aspiration in young infants: a randomized, controlled trial[J]. Clin J of Pain, 2007, 23(9): 756-759. doi: 10.1097/AJP.0b013e318153497c
    [43] MODEKWE V I, UGWU J O, EKWUNIFE O H, et al. Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision[J]. Niger J Clin Pract, 2019, 22(12): 1737-1741. doi: 10.4103/njcp.njcp_266_19
    [44] 李艾伦, 仓静. 局麻药在术后慢性疼痛预防及治疗中的作用[J]. 中华全科医学, 2020, 18(5): 830-834. doi: 10.16766/j.cnki.issn.1674-4152.001368

    LI A L, CANG J. Effect of local anesthetics on the prevention and treatment of chronic post-surgical pain[J]. Chinese Journal of General Practice, 2020, 18(5): 830-834. doi: 10.16766/j.cnki.issn.1674-4152.001368
    [45] KAUFMAN G E, CIMO S, MILLER L W, et al. An evaluation of the effects of sucrose on neonatal pain with 2 commonly used circumcision methods[J]. Am J Obstet Gynecol, 2002, 186(3): 564-568. doi: 10.1067/mob.2002.121621
    [46] LINHARES M B M, GASPARDO C M, SOUZA L O, et al. Examining the side effects of sucrose for pain relief in preterm infants: a case-control study[J]. Braz J Med Biol Res, 2014, 47(6): 527-532. doi: 10.1590/1414-431X20143659
    [47] LIU M F, LIN K C, CHOU Y H, et al. Using non-nutritive sucking and oral glucose solution with neonates to relieve pain: a randomised controlled trial[J]. J Clin Nurs, 2010, 19(11-12): 1604-1611. doi: 10.1111/j.1365-2702.2009.03014.x
    [48] RAZAGHI N, AEMMI S Z, SADAT HOSEINI A S, et al. The effectiveness of familiar olfactory stimulation with lavender scent and glucose on the pain of blood sampling in term neonates: a randomized controlled clinical trial[J]. Complement Ther Med, 2020, 49: 102289. DOI: 10.1016/j.ctim.2019.102289.
    [49] DAVARI S, BORIMNEJAD L, KHOSRAVI S, et al. The effect of the facilitated tucking position on pain intensity during heel stick blood sampling in premature infants: a surprising result[J]. J Matern Fetal Neonatal Med, 2019, 32(20): 3427-3430. doi: 10.1080/14767058.2018.1465550
    [50] 韩敏, 朱莉, 徐兵. 医护一体PDCA护理模式对新生儿PICC护理的效果观察[J]. 中华全科医学, 2021, 19(9): 1604-1607. doi: 10.16766/j.cnki.issn.1674-4152.002122

    HAN M, ZHU L, XU B. Observation on the effect of PDCA nursing model of integrated medical and nursing on newborn PICC nursing[J]. Chinese Journal of General Practice, 2021, 19(9): 1604-1607. doi: 10.16766/j.cnki.issn.1674-4152.002122
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  • 收稿日期:  2022-02-23
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