布比卡因局部喷雾用于患儿扁桃体切除术后镇痛的临床研究

The clinical research of bupivacaine spray attonsillar fossa on post-tonsillectomy pain in children

目的观察布比卡因局部喷雾用于患儿扁桃体切除术后镇痛的效果。方法择期行全麻下扁桃体摘除手术患儿40例,男31例,女9例,年龄6～12岁,ASAⅠ或Ⅱ级,随机均分为布比卡因组和对照组。布比卡因组用0.5%布比卡因不超过1mg/kg(含1∶200 000肾上腺素)于止血彻底后行双侧扁桃体窝喷雾,对照组采用生理盐水。记录苏醒时间、气管导管拔管的时间、手术时间,于苏醒后即刻、1、4、8、12、16和24h行疼痛VAS评分,观察两组镇痛效果和不良反应发生情况。结果苏醒后即刻、1、4、8h,布比卡因组的疼痛VAS评分均明显低于对照组(P<0.05或P<0.01)。术后布比卡因组有2例患儿出现恶心,1例呕吐反应,对照组有3例患儿出现恶心,1例呕吐反应,两组差异无统计学意义。结论布比卡因局部喷雾可有效地减轻患儿扁桃体切除术后早期疼痛,无局部麻醉药的不良反应,可提高患儿手术后生理舒适度。

Objective To observe the effects of peritonsillar spray of bupivacaine attonsillar fossa on post-tonsillectomy pain in children.Methods Forty ASA I or III children aged 6 12 years, male 31, female 9, undergoing elective tonsillectomy were randomly divided into two groups. Group bupivaeaine （n=20） received 0.5% bupivacaine, and group control （n = 20） received 0.9% NaCI （saline） sprayed around each tonsillectomy fossa after the end of operation.Operation time, extubation time, and wake up time were recorded. Pain was evaluated using a visual analog scale（VAS） at 0,1, 4, 8, 12, 16 and 24 h after regain consciousness. Results Pain scores in group bupivacaine were significantly lower at 0,1, 4, and 8 h postoperatively compared to the group control. There was no significantly difference in nausea and vomitting between the two groups.Two children had nausea and one had vomitting in group bupivacaine. Three children had nausea and one had vornitting in group control （P〈0.05 or P〈0. 01）.Conclusion Bupivacaine spray attonsillar fossa is a safe and effective method for relief of pediatric post-tonsillectomv nain.