超声引导下髂腹下-髂腹股沟神经阻滞在小儿腹股沟区手术中的应用

Application of Ultrasound-guided Ilioinguinal-iliohypogastric Nerve Block in Pediatric Inguinal Surgery

目的探讨超声引导下髂腹下-髂腹股沟神经阻滞在小儿腹股沟区手术中的安全性、有效性以及术后镇痛的效果。方法选取本院收治的100例腹股沟区手术患儿,将其随机分为超声组(U组)与传统组(T组),每组各50人。超声组予以喉罩全麻后在B超引导下行髂腹下-髂腹股沟神经阻滞(使用0.2%罗哌卡因和0.5%利多卡因混合液0.2 ml·kg^(-1)),传统组予以喉罩全麻后在体表标志定位下行髂腹下-髂腹股沟神经阻滞(等量局麻药)。记录两组患儿入手术室时(T0)、切皮时(T1)、缝皮时(T2)的HR、MAP、SpO_2。记录患者手术时间、苏醒时间、PACU停留时间、丙泊酚及芬太尼总用量,记录术中镇痛不足需增加镇痛药的例数。观察记录术中体动、恶心呕吐、术后躁动等不良反应。在苏醒时、术后2 h及8 h采用FLACC行疼痛评分,评分>3分者予对乙酰氨基酚栓剂塞肛,记录两组术后镇痛无效的例数。结果 U组各时点HR、MAP、SpO_2变化不大(P>0.05);T组T1较T0心率增快、血压升高(P<0.05),T1心率和血压T组较U组明显增高(P<0.05);U组苏醒时间、PACU停留时间、所需丙泊酚和芬太尼用量较T组明显减少(P<0.05);U组患儿在苏醒时、术后2 h疼痛评分较T组明显降低,术中镇痛不足需增加镇痛药的例数及术后镇痛无效的例数明显少于T组(P<0.05);U组患儿术中体动、术后躁动发生率较T组低(P<0.05)。结论超声引导下髂腹下-髂腹股沟神经阻滞应用于小儿腹股沟区手术,麻醉效果确切,成功率高,副作用少,术后镇痛效果好。

Objective To explore safety and validity of ultrasound-guided ilioinguinal-iliohypogastric nerve block(INB)in pediatric inguinal surgery and effect of postoperative analgesia.Methods 100 children to undergo inguinal surgeries were selected and randomly divided into ultrasound group(group U)and traditional group(group T),with 50 cases in each group.After received general anesthesia with laryngeal mask,Group U was given ultrasound guidance for INB with 0.2 ml/kg mixture of 0.2%ropivacaine and 0.5%lidocaine,while group T got landmark-based INB with the same local anesthetic.The two groups were compared in terms of heart rate(HR),mean arterial pressure(MAP)and sphygmus oxygen saturation(SpO 2)of children at the time of entering operating room(T0),skin incision(T1)and skin suture(T2).The operation and recovery time,retention time of post anesthesia care unit(PACU),total amount of propofol and fentanyl and the number of cases with additional intraoperative analgesic and the adverse reactions such as movement during operation,nausea,vomiting and postoperative agitation were recorded.FLACC pain was scaled at the time of recovery,2 h and 8 h after operations,and the children with a score of over-3 points were treated with rectalacetaminophen.The cases with useless postoperative analgesia were accounted.Results There were no significant differences in HR,MAP and SpO 2 at each time point of group U(P>0.05),while HR and MAP of group T at T1 were higher than those at T0(P<0.05),and were higher than those of group U as well(P<0.05).The recovery time,retention time of PACU,total amount of propofol and fentanyl in group U were significantly shorter than those of group T(P<0.05).FLACC scores at recovery and 2 h after operations in group U were lower than those in group T.Tthe number of cases with additional analgesic during operations and cases with useless analgesia operations in group U were significantly lower than those in group T(P<0.05).The rates of patients’movement during operations and postoperative agitation in group U were lower than those of group T(P<0.05).Conclusion Ultrasound-guided INB in pediatric inguinal surgery is effective in anesthesia.It achieves a higher success rate and better postoperative analgesia with less side effects.