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目的 探讨小儿硬膜外腔超前、术毕和术后注射吗啡的临床镇痛效果及安全性。方法 ８０ 例硬膜外麻醉下行下肢手术的小儿随机分为ＥＭ、ＮＳ、ＰＭ 及ＰＯ组；ＥＭ组在硬膜外注药前２０ ｍｉｎ 经导管注０ ．０４ ｍｇ·ｋｇ－１ 吗啡５ ｍｌ，ＰＭ组在术毕经导管注同量吗啡，ＮＳ组注同容量生理盐水，ＰＯ组在术后２ ｈ 经导管注同量吗啡。术后３６ ｈ内随访并记录疼痛（ＶＡＳ） 、镇静及恶心呕吐（ＰＯＮＶ） 评分、平均动脉压和尿潴留等并发症的发生率。结果 ＥＭ、ＰＭ及ＰＯ组术后２４ ｈ ＶＡＳ和ＰＯＮＶ评分均低于ＮＳ组，镇静评分高于ＮＳ组（ Ｐ＜ ０．０５） ；ＥＭ 组术后２ ｈ ＶＡＳ和ＰＯＮＶ评分高于ＰＭ组，４ ｈ ＰＯＮＶ评分低于ＰＭ 组（ Ｐ＜０．０５） 。结论 经充分补液后，小儿硬膜外吗啡超前和术毕使用均可安全地用于术后镇痛。
Objective To investigate the clinical analgesic effect and safety of pediatric epidural anesthesia in advance, at the completion of surgery and postoperative injection of morphine. Methods Eighty children undergoing epidural anesthesia for lower extremity surgery were randomly divided into EM, NS, PM and PO groups. The EM group was catheterized 0 min before epidural injection. 4 mg · kg-1 morphine 5 ml. In the PM group, the same amount of morphine was injected through the catheter at the end of operation, and the same volume of normal saline was injected into the NS group. The same volume of morphine was injected into the PO group at 2 h after operation. Follow-up was performed within 36 hours postoperatively, and the incidences of pain (VAS), sedation and nausea and vomiting (PONV), mean arterial pressure and urinary retention were recorded. Results The scores of VAS and PONV in EM, PM and PO groups were lower than those in NS group and sedation score 24 h after operation (P <0.05). The scores of VAS and PONV in EM group were higher than those in PM group 2 h after operation. 4 h PONV score was lower than PM group (P <0.05). Conclusion After full rehydration, pediatric epidural morphine can be used safely and safely for postoperative analgesia.