连续腋路臂丛神经阻滞在小儿手外科术后镇痛中的应用

Application of continuous axillary brachial plexus block in postoperative analgesia after pediatric hand surgery

目的 总结连续腋路臂丛神经阻滞应用于小儿手外科术后的镇痛效果.方法 选择2011年6月至2012年12月期间我院麻醉科拟行手术的80例患儿,年龄5～10岁,均符合本研究的纳入标准,采用随机对照的方法,按照患者手术时间分为对照组35例和观察组45例,两组患儿行腋路臂丛神经阻滞麻醉,术后对照组采用芬太尼自控静脉镇痛,观察组采用0.25％甲磺酸罗哌卡因和芬太尼连续自控臂丛镇痛.在术后不同时相点对患儿采用视觉模拟评分法,观察比较两组患儿在术后疼痛程度、按压自动镇痛泵次数和术后不良反应发生情况.结果 两组患儿分别在术后1h、2h、4h、8h、12h、20 h、24 h、36h及48 h共9个时相点进行访视,其中,观察组患儿在术后第2h、4h、8h、12h、20h、24h、36h及48 h疼痛VAS评分少于对照组,差异有统计学意义（P＜0.05）,同时,观察组患儿按压自动镇痛泵次数少于较对照组,术后恢复较好,不良反应少于对照组（P＜0.01）.结论 连续腋路臂丛神经阻滞在小儿手外科术中应用较好,具有镇痛效果明显、术后不良反应低的优势.

Objective To observe the effect of continuous axillary brachial plexus block in postoperative analgesia after pediatric hand surgery.Methods Eighty patients undergoing surgery from June 2011 to December 2012 in the Department of Anesthesiology in our hospital,aged 5～10 years old,were enrolled in this study.By randomized controlled （RCT） method,the patients were divided into the control group （n=35） and observation group （n=45） according to the operation time.The two groups of children underwent axillary brachial plexus anesthesia.The controlgroup controlled intravenous analgesia with fentanyl,while the observation group applied 0.25％ mesylate ropivacaine and fentanyl for continuous controlled brachial plexus analgesia.The degree of postoperative pain,frequency of pressing the analgesia pump,and postoperative adverse events were observed by Visual Analog Scale （VAS） at different time points and compared between the two groups.Results Two groups of children were interviewed 1 h,2 h,4 h,8 h,12 h,20 h,24 h,36 h and 48 h after treatment.The VAS scores in the observation group 8 h,12 h,20 h,24 h,36 h and 48 h after treatment were significantly lower than those in the control group （P＜0.05）.At the same time,in the observation group,the number of times of pressing the analgesia pump was less,postoperative recovery was better,and the adverse reactions were fewer （P＜0.01）.Conclusion Continuous axillary brachial plexus block has good analgesic effect in pediatric hand surgery,with less postoperative adverse advantages.