收肌管阻滞与股神经阻滞在患儿胫骨骨折闭合复位术中的比较

Comparison of adductor canal block with femoral nerve block in pediatric patients undergoing closed reduction of tibial fracture

目的比较收肌管阻滞和股神经阻滞在患儿胫骨骨折闭合复位术中的麻醉效果。方法择期于全麻下行胫骨骨折闭合复位的患儿60例,男34例,女26例,ASAⅠ或Ⅱ级。采用随机数字表法分为三组:对照组(C组)、股神经阻滞组(F组)和收肌管阻滞组(A组),每组20例。C组采用单纯全麻,F组和A组在全麻后分别行股神经阻滞和收肌管阻滞(0.2%罗哌卡因0.5 ml/kg)。记录诱导前、切皮前、切皮后1、15 min、手术结束即刻和拔除喉罩后5 min的HR、MAP和SpO_(2)。记录术中瑞芬太尼用量、苏醒时间、布洛芬初次使用时间及术后24 h布洛芬用量。结果与C组比较,F组、A组切皮后1、15 min、手术结束即刻和拔除喉罩后5 min的MAP明显降低,HR明显减慢,拔除喉罩后5 min的SpO_(2)明显升高,术中瑞芬太尼用量明显减少,苏醒时间明显缩短,布洛芬初次使用时间明显延迟,术后24 h布洛芬用量明显减少(P<0.05)。与F组比较,A组切皮后1、15 min、手术结束即刻和拔除喉罩后5 min的MAP明显降低,HR明显减慢,拔除喉罩后5 min的SpO_(2)明显升高,术中瑞芬太尼用量明显减少,苏醒时间明显缩短,布洛芬初次使用时间明显延迟,术后24 h布洛芬用量明显减少(P<0.05)。结论收肌管阻滞和股神经阻滞在患儿胫骨骨折闭合复位术均具有良好的镇痛作用,而收肌管阻滞效果优于股神经阻滞。

Objective To compare the effect of adductor canal block with femoral nerve block in pediatric patients undergoing closed reduction of tibial fracture.Methods Sixty children scheduled for elective closed reduction of tibial fracture,34 males and 26 females,ASA physical statusⅠ-Ⅱ,were equally and randomly divided into 3 groups(n=20 in each):control group(group C),femoral nerve block group(group F),and adductor canal block group(group A).Group C received general anesthesia alone,while group F and group A received femoral nerve block and adductor canal block after general anesthesia,respectively.MAP,HR,SpO_(2) were recorded at different time points.The intraoperative doses of remifentanil,awaking time,the time of the first use of lbuprofen and total doses of lbuprofen within 24 hours after surgery were recorded.Results Compared with group C,MAP and HR were significantly decreased 1 minute and 15 minutes after skin incision,immediately after the operation,and 5 minutes after removal of laryngeal mask,and SpO_(2) was significantly increased 5 minutes after removal of laryngeal mask in groups F and A.The intraoperative dosage of remifentanil was significantly reduced,the awaking time was significantly shortened,the time of the first use of ibuprofen was significantly delayed,and the dosage of ibuprofen was significantly reduced within 24 hours after surgery in groups F and A than in group C(P<0.05).Compared with group F,MAP and HR were significantly decreased 1 minute and 15 minutes after skin incision,immediately after the operation,and 5 minutes after removal of laryngeal mask,and SpO_(2) was significantly increased 5 minutes after removal of laryngeal mask in group A.The intraoperative dosage of remifentanil was significantly reduced,the awaking time was significantly shortened,the time of the first use of ibuprofen was significantly delayed,and the dosage of ibuprofen was significantly reduced within 24 hours after surgery in group A than in group F(P<0.05).Conclusion Adductor canal block provides better analgesic efficacy than femoral nerve block when applied for closed reduction of tibial fracture in pediatric patients.