不同浓度罗哌卡因腰方肌阻滞用于腹腔镜手术患儿术后镇痛的效果

Effect of quadratus lumborum block with different concentrations of ropivacaine on postoperative analgesia in children undergoing laparoscopic surgery

目的探讨超声引导下不同浓度罗哌卡因腰方肌阻滞用于患儿腹腔镜手术后镇痛的有效性和安全性。方法选择择期行腹腔镜疝囊和鞘状突高位结扎术患儿69例,男65例,女4例,年龄3~6岁,体重13~24 kg,ASAⅠ或Ⅱ级。采用随机数字表法将患儿分为三组:0.15%罗哌卡因组(C15组,n=23)、0.20%罗哌卡因组(C20组,n=22)和0.25%罗哌卡因组(C25组,n=24)。于手术切皮前行双侧腰方肌阻滞,三组分别注射0.15%、0.20%、0.25%罗哌卡因0.4 ml/kg。记录术后12 h内首次补救镇痛时间、需要补救镇痛例数,术后1、2、4、6、8、10、12 h的FACES评分及苏醒期躁动情况。记录术后穿刺部位血肿、感染、周围脏器损伤、局麻药毒性反应、下肢肌力减退、低血压等腰方肌阻滞相关并发症发生情况。结果C25组术后12 h内首次补救镇痛时间明显晚于C15组(P<0.05),需要补救镇痛例数明显少于C15组(P<0.05)。术后1、2、4 h C25组FACES评分明显低于C15组和C20组(P<0.05)。三组患儿苏醒期躁动发生率差异无统计学意义。所有患儿术后均未出现相关并发症。结论超声引导下0.25%罗哌卡因0.4 ml/kg双侧腰方肌阻滞可推迟腹腔镜疝囊和鞘状突高位结扎术患儿术后12 h内首次补救镇痛时间,且镇痛效果更好。

Objective To investigate the effectiveness and safety of quadratus lumborum block(QLB)with different concentrations of ropivacaine for perioperative analgesia in children undergoing laparoscopic high position ligation of hernia sac and processus vaginalis.Methods Sixty-nine children with laparoscopic herniorrhaphy or sheath process ligation,65 males and 4 males,aged 3-6 years,weighing 13-24 kg,ASA physical statusⅠorⅡ,were randomly divided into three groups:0.15%ropivacaine group(group C15,n=23),0.20%ropivacaine group(group C20,n=22),0.25%ropivacaine group(group C25,n=24).Ultrasound-guided bilateral QLB was performed before surgery,and 0.15%,0.20%,0.25%ropivacaine 0.4 ml/kg were bilaterally injected in groups C15,C20,and C25,respectively.The time of first use of remedial analgesic drugs and the number of children needing remedial analgesia within the first 12 hours were recorded.The FACES scores were evaluated at 1,2,4,6,8,10,and 12 hours after surgery.Incidence of anesthesia emergence delirium and QLB complications such as puncture site hematoma,infection,peripheral organ injury,local anesthetic toxicity,lower limb muscle strength decrease and hypotension were recorded.Results The first time of analgesia was significantly longer in group C25 than that in group C15(P<0.05),the number of children in need of analgesia were significantly less than that in group C15(P<0.05).The 1,2 and 4 hours FACES scores of group C25 were significantly lower than those of group C15 and group C20(P<0.05).There was no significantly difference in the incidence of anesthesia emergence delirium in all the three groups.There were no side effects in all children.Conclusion 0.25%ropivacaine 0.4 ml/kg of ultrasound-guided bilateral quadratus lumborum block could delay the first time of remedial analgesia within the first 12 hours and improve the analgesic effect after laparoscopic high position ligation of hernia sac and processus vaginalis.