超声引导下左布比卡因联合右美托咪啶行肋间神经阻滞对小儿NUSS手术术后镇痛的效果

Analgesic effect of Levobupivacaine combined with Dexmetidine in intercostal nerve block after NUSS operation in children

目的探讨超声引导下左布比卡因联合右美托咪啶行肋间神经阻滞对小儿微创漏斗胸矫形术(NUSS)术后镇静及镇痛效果的影响。方法选择2014年11月1日～2017年3月1日在广州市妇女儿童医疗中心麻醉科择期NUSS手术的3～6岁患儿60例作为研究对象,按照随机数字表法分为BD组、B组、C组3组,每组各20例。对BD组患儿气管插管全身麻醉后给予超声引导下0.25%左布比卡因和1μg/mL右美托咪啶行肋间神经阻滞,术后予阿片类药物静脉自控镇痛(PCIA);对B组患儿气管插管全身麻醉后给予超声引导下0.25%左布比卡因行肋间神经阻滞,术后予PCIA;对C组患儿气管插管全身麻醉后直接手术,术后给予PCIA镇痛。观察及记录各组患儿术后苏醒拔管期Riker镇静躁动评分,术后改良面部表情评分法(FLACC)疼痛评分,术后24h PCIA的有效按压次数和实际按压次数,舒芬太尼术后24h内的累积用量;计算镇痛失效百分比。结果 BD组、B组、C组患儿术后苏醒拔管期Riker镇静躁动评分分别为(4.0±0.0)、(4.0±0.0)、(5.0±0.0)分;术后2、4、6、8、12、24h及48h FLACC疼痛评分显示BD组<B组<C组,组间差异均有高度统计学意义(P<0.01)。三组间术后PCIA有效按压次数及实际按压次数差异均有高度统计学意义(P<0.05);C组患儿有效按压次数与实际按压次数均显著多于B组及BD组,差异有统计学意义(P<0.05)。舒芬太尼24h累积用量为BD组<B组<C组,组间差异有统计学意义(P<0.05)。三组患儿术后的镇痛失效百分比比较,差异有统计学意义(P<0.05)。结论小儿微创漏斗胸矫形术行超声引导下肋间神经阻滞联合PCIA较单纯全身麻醉更能有效减缓术后疼痛,且右美托咪啶能够增强左布比卡因肋间神经阻滞效果,并减少舒芬太尼用量,更适合于NUSS术后镇痛。

Objective To investigate the effect of ultrasound guided Levobupivacaine combined with Dexmedetomidine on postoperative sedation and postoperative pain score in children undergoing NUSS surgery. Methods From November 1, 2014 to March 1, 2017, 60 children aged 3 to 6 years who received NUSS operation in the Department of Anesthesiology of Guangzhou Women and Children′ s Medical Center were selected as the research objects. They were divided into group BD, group B and group C three groups according to the random number table, 20 cases in each group.0.25% Levobupivacaine and 1μg/mL Dexmetidine under ultrasound guidance were used to block intercostal nerve after tracheal intubation and general anesthesia in children of group BD, and postoperative analgesia was performed with opioid drugs by self-controlled intravenous administration of PCIA. 0.25% Levobupivacaine under ultrasound guidance were used to block intercostal nerve after tracheal intubation and general anesthesia in children of group B and PCIA was used for the analgesia after operation. The children in group C were operated directly after general anesthesia with tracheal intubation, and PCIA was given for the analgesia after operation. The Riker sedation agitation score of postoperative recovery and extubation, postoperative FLACC pain score, the effective pressing times and actual pressing times of PCIA the cumulative dosage of Sufentanil within 24h after operation were observed and recorded. The percentage of analgesic failure was calculated. Results The scores ofRiker sedation and restlessness in group BD, B and C were（4.0 ±0.0）,（4.0±0.0） and（5.0±0.0） scores respectively.FLACC pain scores at 2, 4, 6, 8, 12, 24h and 48h after operation showed that group BD group B group C, and the differences between groups were statistically significant（P〈0.01）. There were statistically significant differences among the three groups in the number of effective PCIA compressions and actual compressions（P〈0.05）. The effective times and actual times of compressions in group C were significantly higher than those in group B and BD, and the differences were statistically significant（P〈0.05）. The cumulative dosage of Sufentanil in 24h was group BD group B group C, and the difference was statistically significant（P〈0.05）. The percentage of postoperative analgesia failure in the three groups was statistically significant（P〈0.05）. Conclusion Ultrasound guided intercostal nerve block combined with PCIA is more effective than PCIA alone in relieving postoperative pain in children with NUSS. Dexmetidine can enhance the effect of Levobupivacaine on intercostal nerve block, and lower the dosage of Sufentanil. It is more suitable for postoperative analgesia after NUSS.