超声引导下肋间神经阻滞与椎旁神经阻滞在小儿漏斗胸微创矫正术后的镇痛效果比较

Comparison of Analgesic Effect of Ultrasound-guided Intercostal Nerve Block and Paravertebral Nerve Block in Children with Fungal Chest Minimally Invasive Surgery

目的探讨超声引导下肋间神经阻滞(INB)与椎旁神经阻滞(TPVB)对小儿漏斗胸微创矫正术(NUSS)后镇痛效果的影响。方法选择2017年3月至2018年10月在广州市妇女儿童医疗中心拟行择期手术患儿60例作为研究对象,采用随机数字表将患儿分为INB组(I组)和TPVB组(T组),每组30例。I组在超声引导下于手术切口肋间及其上、下肋间行神经阻滞,T组在超声引导下行双侧T4/T5胸椎旁神经阻滞。于术后2 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)使用脸谱疼痛评分法(FLACC,face、legs、activity、crying、consolability)评估并比较两组疼痛程度,记录并比较两组术后24 h舒芬太尼使用总量,观察并比较两组并发症发生情况。结果组内比较,I组T2、T3的FLACC评分分别高于T1(P<0.05);T组T2的FLACC评分高于T1(P<0.05)。组间比较,T组在T2的FLACC评分明显低于I组,差异有统计学意义(P<0.05)。T组术后24 h舒芬太尼总量明显少于I组(P<0.05)。两组患者均未见神经损伤和局麻药中毒反应。结论超声引导下TPVB在小儿NUSS术后镇痛效果比INB更优,明显减少术后阿片类药物用量,对小儿NUSS术后镇痛具有更大的应用优势。

Objective To investigate the effect of ultrasound-guided intercostal nerve block(INB)and paravertebral nerve block(TPVB)on the analgesic effect of pediatric funnel-thoracic minimally invasive surgery(NUSS).Methods From March 2017 to October 2018,60 children with elective surgery in Guangzhou Women and Children Medical Center were selected as subjects.The children were divided into INB group(group I)and TPVB group(T using random number table).Group,30 cases in each group.In group I,nerve block was performed between the incision ribs and the superior and inferior intercostals under ultrasound guidance.The T group underwent ultrasound-guided bilateral T4/T5 thoracic paravertebral nerve block.Face pain scores(FLACC,face,legs,activity,crying,and consolability)were evaluated and compared between 2 h(T1),12 h(T2),24 h(T3),and 48 h(T4)postoperatively.To the extent,the total amount of sufentanil used in the two groups after surgery was recorded,Observe and compare the occurrence of complications between the two groups.Results In the group,the FLACC scores of T2 and T3 in group I were higher than those in T1(P<0.05).The FLACC score of T2 in group T was higher than that in T1(P<0.05).Compared with the comparison between groups,the FLACC score of T group was significantly lower than that of group I,and the difference was statistically significant(P<0.05).The total amount of sufentanil in group T was significantly lower than that in group I at 24 h after operation(P<0.05).Nerve injury and local anesthetic poisoning were not seen in either group.Conclusion Ultrasound-guided TPVB has better analgesic effect after NUSS in children than INB,which significantly reduces the dosage of postoperative opioids and has greater application advantages for postoperative analgesia in children with NUSS.