关节腔注射布比卡因对肱骨髁上骨折患儿术后疼痛的影响

Effects of intra-articular injection of bupivacaine on postoperative pain in children with supracondylar fracture of humerus

目的 评估关节腔注射0.25%布比卡因对肱骨髁上骨折患儿闭合复位经皮克氏针内固定(CRPP)术后疼痛的影响。方法 对2015年1月至2020年1月在承德医学院附属医院接受CRPP手术的65例GartlandⅡ和Ⅲ型肱骨髁上骨折儿童进行前瞻性研究。将65例随机分为注射组(注射0.25%布比卡因,n=29)和对照组(不行注射,n=36)。记录并比较两组患儿一般资料、骨折分型、穿针数量以及从入院到手术的时间等情况。所有患儿CRPP术后口服布洛芬常规镇痛,记录术后24 h内布洛芬的用药次数和首次用药时间。术后第1天使用修订版面部疼痛量表(FPS-R)进行疼痛评分。并进一步比较不同年龄、不同肱骨髁上骨折Gartland分型以及穿针数量的患儿术后疼痛的差异。结果 注射组术后首次服用布洛芬的时间显著高于对照组[(2.76±0.64) h vs(1.84±0.84) h,t=4.866,P<0.01],同时术后24 h内应用布洛芬的次数明显低于对照组(P<0.05)。注射组患儿FPS-R评分较同一骨折类型、同一克氏针使用数量的对照组有所降低,但差异均无统计学意义(P>0.05)。注射组所有患儿未出现关节腔注射相关并发症。结论 关节腔注射0.25%布比卡因能够减少肱骨髁上骨折患儿CRPP术后对止痛药布洛芬的需求,但对FPS-R疼痛评分的降低尚未达有统计学意义的获益,有待扩大样本量继续探讨。

Objective To evaluate the effects of intra-articular injection of 0.25%bupivacaine on pain after closed reduction and percutaneous pinning(CRPP)in children with supracondylar fracture of the humerus.Methods A prospective cohort study was conducted on 65 children with GartlandⅡandⅢsupracondylar humerus fractures who underwent CRPP surgery in the Affiliated Hospital of Chengde Medical College from January 2015 to January 2020.The children were randomly divided into injection group(0.25%bupivacaine injection,n=29)and control group(without injection,n=36).The general information,fracture classification,number of punctures,and time from admission to surgery were recorded and compared between the two groups of children.After CRPP operation,ibuprofen was taken orally for routine postoperative analgesia.The medication frequency and time of the first administration of ibuprofen within 24 hours after operation were recorded.On the first day after surgery,the revised Facial Pain Scale(FPS-R)was used to score the pain.And further comparison of the differences in postoperative pain among children of different ages,Gartland classification of supracondylar humerus fractures and the number of punctures were carried on.Results Compared with control group,the first medication time of ibuprofen was longer[(2.76±0.64)h vs(1.84±0.84)h,t=4.866,P<0.01],and the medication frequency within 24 hours after operation was lower in injection group(P<0.05).The FPS-R score of injection group was slightly lower than that of control group with the same fracture type and the same number of Kirschner needles,but the difference was not statistically significant(P>0.05).All patients of injection group did not experience complications related to intra-articular injection.Conclusion Intra-articular injection of 0.25%bupivacaine can reduce the demand for ibuprofen after CRPP in children with supracondylar fracture of humerus,but the reduction of FPS-R pain score has not achieved statistical benefits,which needs to be further explored by expanding the sample size.