超声引导下腰方肌阻滞对小儿发育性髋脱位矫形术术后镇痛效果的影响

The ultrasound-guided quadratus lumborum block for postoperative analgesia in children with developmental dysplasia of the hip

目的:评价超声引导下腰方肌阻滞对小儿发育性髋关节脱位矫形术(DDH)术后镇痛效果的影响。方法:收集内蒙古医科大学第二附属医院2018年1月至2019年12月儿骨科小儿发育性髋关节脱位矫形术60例,年龄3~9岁,体重12~26 kg,ASA分级Ⅰ或Ⅱ级。按照随机数字表法分为腰方肌阻滞组( n=30)和单纯全麻组( n=30)。两组全麻诱导给予:瑞芬太尼3 μg/kg+丙泊酚2 mg/kg+罗库溴铵0.6 mg/kg。气管插管后行机械通气,吸入1~1.5 MAC的七氟醚和0.2 μg·kg^(-1)·min^(-1)瑞芬太尼维持麻醉。麻醉后腰方肌阻滞组超声引导下行患侧腰方肌阻滞,给予0.2%罗哌卡因1 ml/kg;单纯全麻组行单纯全麻。记录术中瑞芬太尼用药量;切皮前(T1)、切皮时(T2)、股骨截骨时(T3)及术毕即刻(T4)的平均动脉压(MAP)、心率(HR);术后1、6、24和48 h的疼痛行为学评分(FLACC);术后24 h患儿家属满意度及不良反应发生情况。 结果:与单纯全麻组比较,腰方肌阻滞组术中瑞芬太尼用量为(341±118)μg较单纯全麻组(583±187)μg显著减少( P<0.05),T2、T3、T4时点HR、MAP降低( P均<0.05),术后1、6和24 h时FLACC显著降低( P均<0.05),患儿家属满意度提高,不良反应较少。 结论:超声引导下腰方肌阻滞可增强DDH矫形术术后镇痛效果,减少术中瑞芬太尼的用量,不良反应少。

Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block for the postoperative analgesia in children with developmental dysplasia of the hip.Methods Sixty children with developmental dysplasia of the hip,aged 3-9 years,weighing 12-26 kg,ASA I/lI,in Department of Anesthesiology of the Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to December 2019 were divided into two groups by random number table:ultrasound-guided quadratus lumborum block group and the general anesthesia group(n=30 each).The children were given general anesthesia induction:remifentanil 3μg/kg+propofol 2 mg/kg+rocuronium 0.6 mg/kg in the two groups.After tracheal intubation,mechanical ventilation was performed,and anesthesia was maintained by inhaling sevoflurane of 1-1.5 MAC and intravenous remifentanil 0.2μg·kg'.min'l.After anesthesia induction,the ultrasound-guided quadratus lumborum block was performed on the affected side,and 0.2%ropivacaine 1 ml/kg was injected in the quadratus lumborum block group.The children received general anesthesia only in the general anesthesia group.The consumption of remifentanil during the operation was recored.FLACC scores at 1,6,24 and 48 hours after the operation,side effects and satisfaction of their family members at 24 hours after the operation were recored also.And the MAP,HR were recorded before skin incision(T1),cutting skin(T2),at femoral trochanter osteotomy(T3)and the end of the surgery(T4)in both groups.Results The MAP and HR were significantly lower in the ultrasound-guided quadratus lumborum block group at T2,T3,T4 time points than those in the general anesthesia group(P<0.05).The consumption of remifentanil was(341+118)μg in the quadratus lumborum block group,which was less than that in the general anesthesia group(583±187)μg(P<0.05).The FLACC scores were significantly lower at 1,6 and 24 hours after the operation in the quadratus lumborum block group than those in the general anesthesia group(all P<0.05).The complications were significantly less in the quadratus lumborum block group than those in the general anesthesia group(all P<O.05).Conclusion The quadratus lumborum block guided by ultrasound can enhance the postoperative analgesia in developmental dysplasia of the hip,reduce consumption of remifentanil during the operation,and reduce the adverse reactions.