地塞米松联合罗哌卡因局部浸润用于小儿扁桃体切除术后镇痛的效果

Effect of Dexamethasone Combined with Ropivacaine Peritonsillar Infiltration on Post-tonsillectomy Pain in Children

目的:观察地塞米松联合罗哌卡因局部浸润用于小儿扁桃体等离子切除术后镇痛的效果。方法:择期全麻下行扁桃体切除术的患儿90例,采取随机数字法分为3组,于全麻气管插管后扁桃体周围局部注射罗哌卡因(A组,n=30),或地塞米松和罗哌卡因混合液(B组,n=30),对照组采用生理盐水(C组,n=30)。记录术后30min,1h,2h,4h,8h,12h,24h时东安大略儿童医院改良疼痛评分(mCHEOPS),评分高于5时静脉给予芬太尼1μg/kg。记录术后各组需补救镇痛药的患儿例数,观察不良反应,包括恶心呕吐、呼吸抑制、创面出血。结果:A组、B组在术后各观察时点mCHEOPS疼痛评分均低于对照组(P<0.05)。A组与B组比较,疼痛评分在术后30min、1h、2h时无显著性差异(P>0.05),但在4-24h各观察时点,B组较A组疼痛评分低(P<0.05)。A组、B组需补救镇痛药的患儿明显少于对照组,与A组比较,B组需要补救镇痛药的患儿显著减少(P<0.05)。A组、B组较对照组恶心呕吐的发生率低(P<0.05),两组之间无显著性差异(P>0.05)。3组均未发现呼吸抑制及创面出血。结论:地塞米松联合罗哌卡因扁桃体周围局部浸润用于小儿扁桃体等离子切除可有效减轻术后24h疼痛,且不增加不良反应。

Objective：To investigate the effect of dexamethasone combined with ropivacaine peritonsillar infiltration on post-tonsillectomy pain in children.Methods：Ninety ASA physical statusⅠ andⅡchildren,scheduled for tonsillectomy,were randomized into three groups to either receive ropivacaine（Group A,n=30）,mixture of dexamethasone and ropivacaine（Group B,n=30）or saline as the control（Group C,n=30）peritonsillar infiltration after intubation following general anesthesia.The Modified Children＇s Hospital of Eastern Ontario Pain Scale（mCHEOPS）were recorded postoperatively at end of 30 min,1h,2h,4h,8h,12 h,24h.Fentanyl at 1μg/kg was administered intravenously for rescue analgesia when scale was higher than 5.Cases needed rescue analgesia and side effects including nausea and vomiting,respiratory inhibition,bleeding were also recorded.Results：The mCHEOPS were lower both in Group A and Group B compared with the control（P〈0.05）.No significant difference was found between Group A and Group B at 30 min,1h,2hpostoperatively（P〈0.05）.However,the mCHEOPS were lower in Group B during 4-24 heach time point as compared with Group A（P〈0.05）.Both Group A and Group B need less rescue analgesia compared with the control,while Group B need significantly less compared with Group A（P〈0.05）.Incidence of nausea and vomiting was lower in Group A and Group B（P〈0.05）.No significant difference was found between the two groups（P〈0.05）.None of children developed postoperative respiratory inhibition or bleeding.Conclusion：Dexamethasone combined with ropivacaine peritonsillar infiltration provides efficient pain relief during24 hafter surgery without increasing side effects in children undergoing tonsillectomy.