超声引导下腹横肌平面阻滞在患儿腹腔镜下腹股沟疝手术中的应用

Ultrasound-guided laparoscopic inguinal hernia surgery blocked at transversus abdominal plane in children

目的探讨超声引导下腹横肌平面（TAP）阻滞在腹腔镜下患儿腹股沟疝手术中的作用。方法 56例患儿斜疝患儿随机均分为两组：A组静脉全麻诱导后超声引导下双侧TAP阻滞,每侧注射0.25%盐酸罗哌卡因0.5ml/kg,B组注入等量生理盐水。术中盐酸瑞芬太尼及以2%-5%的七氟醚维持麻醉,观察两组患儿术后苏醒时间、苏醒时躁动发生率、躁动评分、术后镇痛评分、家长满意度及术后追加镇痛药的发生率。结果 A组在苏醒期躁动发生率和躁动评分、术后2、4、8h的FLACC评分均明显低于B组（P〈0.05）,术后12h两组VAS疼痛评分差异无统计学意义。A组术后家长满意度明显高于B组（P〈0.05）。B组术后曲马多使用例数明显多于A组（P〈0.05）。结论超声引导下TAP用于腹腔镜下小儿疝气手术安全有效,可减少小儿苏醒期躁动,减轻术后疼痛,提高家长满意度。

Objective To investigate the effect of ultrasound guided transversus abdominal plane block on laparoscopic inguinal hernia surgery in children.Methods Fifty-six children undergoing inguinal hernia surgery were randomly divided into two groups with 28 cases in each.All children entered into the operation rooms with intravenous access.0.25 levobupivacaine 0.5ml/kg was given to achieve bilateral transversus abdominal plane block guided under ultrasound after general anesthesia in group A.Children in group B were injected equal amounts of saline.General anesthesia was maintained with 2%-5% sevoflurane and remifentanyl infusion.The wakening time,the incidence of restlessness and restless score in recovery period,postoperative pain scale,parentssatisfaction and the need for additional analgesia agents were evaluated.Results The results included gender,age,weight and height,duration of operation,wakening time.None of them was statistically significant.For group A,the incidence of restlessness and restless score in recovery period,the pain assessment scores at 2,4,8hafter operation were all lower than those in group B（P〈0.05）.The difference of the pain scores at 12 hbetween two groups was not statistically significant.Parentssatisfaction was significantly higher in group A than that in group B（P〈0.05）.More patients used tramadol via intravenous injection in group B than in group A（P 0.05）.Conclusion Ultrasound-guided transversus abdominal plane block in laparoscopic inguinal hernia surgery can be safe and effective in children.Meanwhile it alleviates postoperative pain and improves parentssatisfaction.