超声引导选择性前臂神经阻滞在小儿多指畸形中的应用

Application of ultrasound-guided selective nerve block in the forearm for pediatric patients undergoing polydactylism surgery

目的观察超声引导选择性前臂神经阻滞在小儿多指畸形术术后镇痛的应用效果。方法择期行多指畸形矫正手术患儿60例,月龄13～44月,随机分为选择性前臂神经阻滞组(NB组,n=30)和对照组(C组,n=30)。所有患儿均进行喉罩全麻(术中所有用药方案均相同)。NB组根据手术部位选择尺神经或桡神经浅支加正中神经阻滞,于超声引导下每根神经予以0.3%罗哌卡因0.1 ml/kg。C组未予神经阻滞。记录手术时间、苏醒时间、丙泊酚、瑞芬太尼的用量,苏醒期躁动发生率,术后各时点的FLACC评分,曲马多用量,家长满意度以及相关并发症情况。结果两组手术时长无明显差异。与C组相比,NB组术中丙泊酚用量、瑞芬太尼用量、苏醒时间明显减少,苏醒期躁动、术后恶心呕吐发生率明显减少,术后2 h、4 h、8 h、12 h、24 h时点的FLACC评分明显降低,曲马多用量明显减少,家长满意度高。结论超声引导下选择性前臂神经阻滞用于小儿多指畸形手术镇痛效果满意,苏醒迅速,可明显降低苏醒期躁动和术后恶心呕吐的发生率,可在临床上推广应用。

Objective To observe the anaesthetic effect of ultrasound-guided selective nerve block in the forearm for pediatric patients undergoing polydactyly deformity surgery. Methods 60 pediatric patients,aged from 13 to 44 months,undergoing polydactyly deformity surgery were randomly divided into nerve block group( group NB,n= 30) and control group( group C,n = 30). After laryngeal mask anesthesia,the patients in group NB were given 0.3% ropivacaine 0. 1 ml/kg to the ulnar nerve or superficial branch of radial nerve and median nerve according to surgical site respectively. In group C,patients didn’t have nerve block. Time of operation,time of recovery,the propofol and remifentanil consumption during surgery,FLACC score at 2 nd,4 th,8 th,12 th and24 th hour after surgery,cumulative tramadol consumption,agitation rate,the patients ’ satisfaction rate and adverse effects were recorded. Results There was no significant difference in operation time between the two groups. The consumption of propofol and remifentanil and tramadol in NB group was less than that in group C,as well as the time of recovery and the rate of adverse effect. The FLACC score at 2 nd,4 th,8 th,12 th and 24 hourafter surgery in group NB were significantly lower than that in group C. Obtained highly satisfaction of the parents.Conclusions Selective forearm nerve block under the guidance of ultrasound is satisfactory in analgesia and rapid recovery in children with polydigital malformation. It can obviously reduce the incidence of restlessness and postoperative nausea and vomiting during recovery period and can be popularized and applied in clinical practice.