超声引导腹横肌平面阻滞技术对小儿腹股沟疝术后早期镇痛效果的研究

A study of analgesic effect of ultrasound-guided transversus abdominis plane block on early period after pediatric inguinal hernia repair

目的 评价超声引导腹横肌平面阻滞技术在小儿腹股沟疝术后早期镇痛治疗的效果。方法 选取十堰市妇幼保健院3~7岁行单侧腹股沟疝手术的患儿82例,随机分为TAP组和局部浸润组,各41例。TAP组患儿术前采用0.25%左旋布比卡因0.5 ml/kg行腹横肌平面阻滞技术（TAP）,局部浸润组患儿采用0.25%左旋布比卡因0.2 ml/kg术前行伤口浸润,观察两组患者术后第1,2,4,8,12,16,20,24 h的Eastern Ontario儿童医院疼痛评分、首次补救镇痛时间、术后24 h累计补救镇痛药物使用次数和量、副反应恶心和呕吐的率。结果 TAP组患儿的疼痛评分除第1,20,24 h外均低于局部浸润组（P〈0.05）,TAP组患儿首次补救镇痛时间较局部浸润组显著延长（P〈0.05）,术后24 h累计补救镇痛药物使用次数和量均低于局部浸润组（P〈0.05）,副反应恶心和呕吐率两组无明显差异（P〉0.05）。结论 超声引导下TAP阻滞技术在小儿腹股沟疝术后早期有良好的镇痛效果,可以减轻患儿疼痛程度,减少止痛药物使用量,是一种安全有效的镇痛技术。

Objective To evaluate the analgesic effect of ultrasound-guided transversus abdominis plane （TAP） block on early period after pediatric inguinal hernia repair. Method 82 children （age range 3-7 years old） who underwent hernia sac high ligation operation were randomly divided into TAP group and wound infiltration group. Patients in TAP group received TAP block procedure with 0.25% levobupivacaine 0.5 ml/kg, while patients in wound infiltration group received wound infiltration procedure with 0.25% levobupivacaine 0.2 ml/kg. Record the modified Children＇s Hospital of Eastern Ontario Pain Scale score in the 1 th, 2 th, 4 th, 8 th, 12 th, 16 th, 20 th, 24 th hours, time to the first analgesic requirement, number and amount of rescue analgesic requirements, incidence of nausea and vomiting of the two groups. Results Pain scores of TAP group were higher than those in wound infiltration group except in the I th, 20 th, and 24 th hours （P 〈 0.05 ）, time to the first analgesic requirement was shorter than that in wound infiltration group （P 〈 0.01 ）, number and amount of rescue analgesic requirements in the TAP group were lower than those in wound infiltration group （ P 〈 0.05 ）, incidence of nausea and vomiting were similar between the two groups. Conclusion Ultrasound-guided transversus abdominis plane block provides good early period analgesia after pediatric inguinal hernia repair; it can relieve patients pain and reduce usage of painkiller, it is a safe and effective analgesia technology.