耳大神经阻滞对人工耳蜗植入术后患儿苏醒期谵妄的影响

Effect of great auricular nerve block on emergence delirium in children undergoing cochlear implantation

目的 评价耳大神经阻滞对七氟烷全麻人工耳蜗植入术患儿苏醒期谵妄(ED)的影响。方法 择期七氟烷全麻下单侧人工耳蜗植入术患儿80例,0~6岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法分为耳大神经阻滞组(A组)和对照组(B组)。麻醉诱导后,A组在超声引导下耳大神经周围注入0.2%罗哌卡因1 mL,B组在切口周围注射2%利多卡因2 mL。七氟烷维持麻醉。术后使用儿童麻醉苏醒期谵妄量表(PAED)评估ED发生率,使用面部、腿部、活动、哭泣和安慰程度量表(FLACC)评估术后疼痛。PAED≥13分或FLACC≥4分者,给予芬太尼0.5μg/kg静脉注射。记录患儿七氟烷平均用药浓度、ED持续时间、拔管时间、麻醉后恢复室(PACU)停留时间、芬太尼总用药量、护士满意度评分和术后24 h内不良反应发生率。结果 与B组比较,A组ED发生率(P=0.036)和PAED(P=0.024)评分降低,FLACC评分(P=0.008)和FLACC≥4分的比率(P=0.006)降低,芬太尼补救镇痛率(P=0.011)降低,PACU停留时间(P=0.040)缩短,护士满意度(P=0.021)得到改善(P均<0.05),PAED≥13分的比率(P=0.289)、ED持续时间(P=0.962)、拔管时间(P=0.913)和术后不良反应发生率(P呕吐=0.737;P呛咳=0.487;P低氧=1.000)差异无统计学意义(P均>0.05)。结论 耳大神经阻滞能降低七氟烷全麻人工耳蜗植入术后儿童苏醒期谵妄的发生率、减轻术后疼痛且不增加术后不良反应发生率。

Objective To evaluate the effect of great auricular nerve block on emergence delirium(ED) in children undergoing cochlear implantation with sevoflurane general anesthesia. Methods We enrolled 80 children(0-6 years) with American Society of Anesthesiologists status Ⅰ or Ⅱ who were scheduled for unilateral cochlear implantation under sevoflurane general anesthesia. The patients were randomly assigned to the great auricular nerve block group(group A) or the control group(group B). After the induction of anesthesia, 1 mL of 0.2% ropivacaine was injected around the auricular nerve under ultrasound guidance in group A, while 2 mL of 2% lidocaine was injected around the incision in group B. General anesthesia was maintained with sevoflurane. The incidence of ED was assessed using the pediatric anesthesia acute delirium scale(PAED), while postoperative pain was assessed using the face, legs, activity, cry and consolability(FLACC) scale. Patients with a PAED≥13 or FLACC≥4 were given fentanyl 0.5 μg/kg intravenously. Average sevoflurane dosage, ED duration, extubation time, duration of post-anesthesia care unit(PACU) stay, total fentanyl dosage, nurse satisfaction score, and incidence of adverse reactions within 24 hours postoperative were recorded. Results The incidence of ED(P=0.036)and PAED(P=0.024) score were significantly decreased in group A versus B, FLACC score(P=0.008) and the incidence of FLACC≥4(P=0.006)were significantly decreased, the incidence of analgesia with fentanyl(P=0.011)was significantly decreased, duration of PACU(P=0.040)residence was significantly shortened, and nurse satisfaction(P=0.021)was significantly improved(all P<0.05). No significant change was found in group A in the incidence of PAED≥13(P=0.289), ED duration(P=0.962), extubation time(P=0.913), and the incidence of postoperative adverse reactions(PVomit=0.737;Pchoking=0.487;Phypoxia=1.000)(all P>0.05). Conclusion A great auricular nerve block can reduce the incidence of ED and postoperative pain in children under sevoflurane general anesthesia without increasing the incidence of postoperative adverse events.