不同浓度罗哌卡因髂腹下和髂腹股沟神经阻滞用于睾丸固定术后镇痛的效果

Effects of iliohypogastric/ilioinguinal nerve block with different concentrations of ropivacaine on postoperative analgesia in patients undergoing unilateral testicular fixation

目的探讨不同浓度罗哌卡因髂腹下和髂腹股沟神经阻滞(iliohypogastric/ilioinguinal nerve block,IINB)用于患儿单侧睾丸固定术后镇痛的有效性和安全性。方法选择首次行单侧睾丸固定术患儿69例,年龄1~6岁,体重9~24 kg,ASA Ⅰ或Ⅱ级,随机分为三组:0.20%罗哌卡因组(R20组)、0.25%罗哌卡因组(R25组)、0.30%罗哌卡因组(R30组),每组23例。全身麻醉下行单侧睾丸固定术,术毕行患侧超声引导IINB,R20组、R25组和R30组分别注射0.20%、0.25%、0.30%罗哌卡因1 mg/kg。记录患儿进入PACU即刻(T0)、术后1 h(T1)、2 h(T2)、4 h(T3)、6 h(T4)、8 h(T5)和24 h (T6)的HR、MAP、FLACC评分和Comfort评分;分别在术前、术毕、术后6 和24 h采集静脉血测定血清P物质浓度。记录术后补救性镇痛药物使用情况和局麻药毒性反应、穿刺部位血肿、股四头肌肌力减退等不良反应。结果 T1—T6时R30组HR明显慢于R20组(P<0.05),T2、T3、T5时R30组HR明显慢于R25组(P<0.05)。T0—T6时R25组和R30组MAP明显低于R20组(P<0.05)。T3、T4时R25组和T2—T4时R30组FLACC评分均明显低于R20组(P<0.05)。T4时R25组和T0、T3、T4时R30组Comfort评分明显低于R20组(P<0.05)。术后6 和24 h R25组和R30组血清P物质浓度均明显低于R20组(P<0.05)。术后24 h内R30组追加补救性镇痛药物明显少于R20组(P<0.05)。三组患儿均未出现局麻药毒性反应、穿刺部位血肿、股四头肌肌力减退等不良反应。结论与0.20%罗哌卡因比较,0.25%、0.30%罗哌卡因1 mg/kg超声引导下髂腹下和髂腹股沟神经阻滞用于患儿单侧睾丸固定术后镇痛更为安全有效,可以在临床推广应用。

Objective To investigate the effectiveness and safety of iliohypogastric/ilioinguinal nerve block(IINB) with different concentrations of ropivacaine for postoperative analgesia in patients undergoing unilateral testicular fixation. Methods Sixty-nine children scheduled for unilateral testicular fixation under general anesthesia, aged 1-6 years, weighing 9-24 kg, ASA physical statusⅠ or Ⅱ, were randomly divided into three groups(n = 23 each): 0.20% ropivacaine group(group R20), 0.25% ropivacaine group(group R25) and 0.30% ropivacaine group(group R30). Ultrasound-guided IINB was performed after surgery, and ropivacaine 1 mg/kg was infected into the operated side. HR, MAP, the FLACC scores, and the Comfort scores were evaluated at entering PACU(T0), 1 h(T1), 2 h(T2), 4 h(T3), 6 h(T4), 8 h(T5), and 24 h(T6) after surgery. The serum substance P concentrations were measured respectively before surgery, after surgery, at 6 and 24 h after surgery. Also, the dosage of rescue analgesia and adverse effects such as local anesthetic toxicity, hematoma at puncture site and quadriceps femoris hypodynamia were recorded. Results Compared with group R20, HR from T1 to T6 were lower in group R30(P < 0.05);compared with group R25, HR at T2, T3, and T5 were lower in group R30(P < 0.05). Compared with group R20, MAP from T0 to T6 were decreased in group R25 and group R30(P < 0.05). Compared with group R20, the FLACC scores were decreased from T2 to T4 in group R30 and at T3, T4 in group R25(P < 0.05), the Comfort scores were decreased at T0, T3 and T4 in group R30 and at T4 in group R25(P < 0.05). Compared with group R20, the serum substance P concentrations were decreased at 6 and 24 h after surgery in group R25 and group R30(P < 0.05), the dosage of rescue analgesia was decreased within 24 h after surgery in group R30(P < 0.05). There were no side effects such as local anesthetic toxicity, hematoma at puncture site and quadriceps femoris hypodynamia in all three groups. Conclusion Compared with 0.20% ropivacaine, 0.25% and 0.30% ropivacaine 1 mg/kg can provide safe and effective analgesia of IINB after unilateral testicular fixation, and they can be applied in clinical practice.