酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响

Influence of Preemptive Analgesia by Ketorolac Combined with Sacral Canal Block on Postoperative Analgesic Effect in Pediatric Patients Undergoing Circumcision

目的:观察酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响。方法:选择我院择期拟行包皮环切术的患儿60例,随机分为酮咯酸氨丁三醇组(K组)、骶管阻滞组(D组)、酮咯酸氨丁三醇联合骶管阻滞组(KD组),每组20例。K组和KD组患儿于麻醉诱导前15 min静脉注射酮咯酸氨丁三醇0.5 mg·kg^-1。D组和KD组患儿术前行骶管阻滞麻醉,并于穿刺成功后一次性注入局麻药物0.8%利多卡因+0.25%罗哌卡因混合液1 ml·kg^-1。观察3组患儿术中体动、芬太尼和丙泊酚的使用情况、术后麻醉苏醒和麻醉苏醒后在麻醉后监测治疗室(PACU)的停留时间、术后补救镇痛情况和不良反应发生情况。结果:与K组相比,D组和KD组患儿术中体动发生率和术后布洛芬混悬液的服用率明显降低,术中芬太尼和丙泊酚的总用量明显减少,术后麻醉苏醒以及麻醉苏醒后在PACU的停留时间明显缩短(P<0.05)。D组布洛芬混悬液服用率明显高于KD组(P<0.05)。3组患儿术后均未见呼吸抑制、恶心、呕吐、瘙痒和尿潴留等不良反应的发生。结论:对于小儿包皮环切术患者,酮咯酸氨丁三醇联合骶管阻滞的术后镇痛效果确切且提供了高质量的术后苏醒。

Objective:To investigate the influence of preemptive analgesia by ketorolac combined with sacral canal block on the postoperative analgesic effect in pediatric patients undergoing circumcision.Methods:A total of sixty pediatric patients received circumcision were randomly divided into three groups with 20 pediatric patients in each group:ketorolac group(group K),sacral canal block group(group D)and ketorolac combined with sacral canal block group(group KD).Intravenous injection of ketorolac 0.5 mg·kg^-1 was performed in group K and group KD 15 min before anesthesia induction.The pediatric patients underwent sacral canal block with a mixture of 1 ml·kg^-1 of 0.8%lidocaine and 0.25%ropivacaine before the operation in group D and group KD.The incidence of intraoperative body movement and postoperative adverse reactions in the 3 groups were observed.The total consumption of intraoperative fentanyl and propofol were recorded.The anesthesia recovery time and the residence time in PACU after resuscitation were recorded.Oral ibuprofen suspension was used for the postoperative analgesia,and the usage of ibuprofen suspension was recorded.Results:Compared with group K,group D and group KD significantly reduced the incidence of body movement and the requirement for ibuprofen suspension,reduced the total consumption of fentanyl and propofol,and shortened the anesthesia recovery time and the residence time in postanesthesia care unit(PACU)after resuscitation(P<0.05).In addition,the incidence of requirement for ibuprofen suspension in group D was significantly higher than that in group KD(P<0.05).No pediatric patient developed postoperative adverse reactions such as respiratory depression,nausea,vomiting,pruritus and urinary retention in the three groups.Conclusion:Ketorolac combined with sacral block analgesia is effective for the postoperative analgesia in pediatric circumcision patients,which provides high quality postoperative recovery.