不同浓度罗派卡因腹横肌平面阻滞在小儿疝气术后镇痛中的效果比较

Effect comparison of transversus abdominis Plan block using different concentration ropivacaine in postoperative analgesia of pediatric hernia

目的:比较超声引导下不同浓度罗派卡因腹横肌平面(transversus abdominis plan,TAP)阻滞在小儿疝气术后镇痛效果。方法:选取2016年6月至2017年6月50例拟行手术治疗的小儿疝气为研究对象。按照随机数字法分为观察组(L组)和对照组(H组),各25例。L组采用0.250%罗派卡因0.5 mL/kg进行TAP阻滞,H组采用0.375%罗派卡因0.5 mL/kg进行TAP阻滞。比较2组患儿麻醉前、置入喉罩后、切皮前、切皮后1 min、术毕时平均动脉压(MAP)和心率(HR)、麻醉时间、FLACC量表评分、有效镇痛时间、镇痛泵按压次数及术后发生恶心呕吐、腹胀便秘、下肢麻木患儿例数。结果:2组MAP和HR在麻醉前、置入喉罩后、切皮前和切皮后1 min 4个时间点差异均无统计学意义(P>0.05),在术毕时L组MAP和HR均高于H组患儿(P<0.01和P<0.05);2组手术时间、FLACC量表评分、术后有效镇痛时间、镇痛泵按压次数方面差异均无统计学意义(P>0.05)。L组患儿术后不良反应发生率4.0%,低于H组的32.0%(P<0.05)。结论:超声引导下0.250%罗派卡因0.5 mL/kg行TAP神经阻滞复合静脉镇痛泵使用,可以满足小儿疝气术后镇痛的需求,不良反应少,是多模式镇痛的较佳选择。

Objective:To compare the analgesic effects of transversus abdominis Plan(TAP)block using different concentrations of ropivacaine guided by ultrasound on children after hernia operation.Methods:Fifty children with hernia scheduled by operation from June 2016 to June 2017 were randomly were divided into the observation group(group L,25 cases)and control group(group H,25 cases).The group L was treated with TAP block using 0.250%ropivacaine,and the group H was dealed with 0.5 mL/kg of 0.375%ropivacaine in TAP block.The MAP,HR,anesthesia time,operation time,Face Leg Activity Crying Consolability(FLACC)scale score,effective analgesic time,and pressing time of pressure-relieving pump between two groups were compared before anesthesia,after laryngeal mask implantation,at 1 min before and after of skin resection and after surgery.Results:The differences of MAP and HR between two groups before anesthesia,after laryngeal mask implantation,at 1 min before and after of skin resection were not statistically significant(P>0.05),and the MAP and HR in group L were higher than those in group H at the end of operation(P<0.01 and P<0.05).The differences of the operation time,FLACC scale score,postoperative effective analgesic time,and pressing time of pressure-relieving pump between two groups were not statistically significant(P>0.05),and the incidence rate of adverse reaction in group L(4.0%)was lower than that in group H(32.0%)(P<0.05).Conclusions:TAP nerve block using 0.250% ropivacaine at 0.5 mL/kg guided by ultrasound combined with intravenous analgesia pump can meet the need of postoperative analgesia,which has little adverse reaction and is a better choice in multiple mode analgesia.