超声引导连续臂丛神经阻滞用于患儿上肢骨折固定术后镇痛的效果

Efficacy of ultrasound-guided continuous brachial plexus block for analgesia after fixation of upper extremity fractures in pediatric patients

目的 评价超声引导连续臂丛神经阻滞用于患儿上肢骨折固定术后镇痛的效果.方法 选取肱骨远端骨折拟行切开复位内固定术的患儿60例,性别不限,年龄3-10岁,体重13 - 46kg,身高97- 152 cm,ASA分级Ⅰ级,采用随机数字表法分为2组（n=30）：静脉镇痛组（Ⅴ组）和连续臂丛神经阻滞组（B组）.2组患儿均在臂丛神经阻滞联合全身麻醉下完成手术.术毕Ⅴ组行PCIA,B组行连续臂丛神经阻滞（0.1％罗哌卡因250 ml,背景输注剂量0.1 ml·kg^-1·h^-1,PCA剂量0.2ml/kg,锁定时间30 min）.采用曲马多进行补救镇痛.于术后2、4、8、12、24、36和48 h时记录Ramsay镇静评分,记录镇静过度的发生情况;记录补救镇痛药物使用情况和镇痛期间呼吸抑制、头晕、恶心呕吐、皮肤瘙痒、尿潴留的发生情况;B组记录血管神经损伤、局部血肿、气胸等发生情况;记录家属对镇痛的满意度.结果 与Ⅴ组比较,B组术后2-12h时Ramsay镇静评分、镇静过度、恶心和头晕发生率、曲马多使用率降低（P〈0.05）,家属对于镇痛满意度差异无统计学意义（P〉0.05）.B组未见血管神经损伤、局部血肿、气胸等不良反应发生.结论 超声引导连续臂丛神经阻滞可安全有效地用于患儿上肢骨折固定术后镇痛.

Objective To evaluate the efficacy of ultrasound-guided continuous brachial plexus block for analgesia after fixation of upper extremity fractures in the pediatric patients.Methods Sixty American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,aged 3-10 yr,weighing 13-46 kg,with body height of 97-152 cm,scheduled for open reduction and internal fixation of distal humeral fractures,were selected and divided into 2 groups （n =30 each） using a random number table：intravenous analgesia group （group Ⅴ） and continuous brachial plexus block group （group B）.Surgery was completed under brachial plexus block combined with general anesthesia in the two groups.At the end of surgery,patient-controlled intravenous analgesia was used in group Ⅴ,and continuous brachial plexus block was performed with 0.1% ropivacaine 250 ml （background infusion 0.1 ml·kg^-1·h^-1,bolus dose 0.2 ml/kg,lockout interval 30 min） in group B.Tramadol was given as rescue analgesic when necessary.Ramsay sedation scores were assessed and recorded at 2,4,8,12,24,36 and 48 h after surgery,and the development of over-sedation was recorded.The require,nent for rescue analgesics and development of respiratory depression,dizziness,nausea and vomiting,pruritus and urinary retention during analgesia were recorded.The development of adverse reactions such as vascular and nerve injury,local hematoma and pneumothorax was recorded in group B.Family＆#39;s satisfaction with analgesia was assessed and scored.Results Compared with group Ⅴ,Ramsay sedation scores at 2-12 h after surgery,the incidence of oversedation,nausea and dizziness and requirement for tramadol were significantly decreased （P〈0.05）,and no significant change was found in the degree of family＆#39;s satisfaction with analgesia in group B （P〉 0.05）.The adverse reactions such as vascular and nerve injury,local hematoma or pneumothorax were not found in group B.Conclusion Ultrasound-guided continuous brachial plexus block can be safely and effectively used for analgesia after fixation of upper extremity fractures in the pediatric patients.