小剂量地塞米松复合罗哌卡因行舌咽神经阻滞对小儿全麻术后疼痛及炎症反应的影响

Effect of the glossopharyngeal nerve block of low dose dexamethasone combined withropivacaine on postoperative pain and inflammation in children after general anesthesia

目的:观察小剂量地塞米松复合盐酸罗哌卡因行舌咽神经阻滞对小儿扁桃体切除术后疼痛及炎症反应的影响。方法:选择行小儿扁桃体切除术的择期患儿80例,ASA分级Ⅰ~Ⅱ级。采用随机数字法分为2组,罗哌卡因组(L组)和复合组(LD组),各40例。L组采用0.25%盐酸罗哌卡因共2 mL,LD组采用0.25%盐酸罗哌卡因+地塞米松0.1 mg/kg共2 mL。记录术后即刻、术后24 h、2组术后48 h患儿静息及吞咽时FLACC评分、炎症因子水平及不良反应发生率等。结果:术后48h LD组的FLACC评分比L组低(P<0.05);LD组术后首次进食时间比L组更早(P<0.01);LD组术后即刻和48h C反应蛋白(CRP)、白细胞介素(IL)-1β、IL-6水平均比L组低(P<0.05);LD组术后发热发生率低于L组(P<0.05)。结论:小剂量地塞米松复合罗哌卡因进行舌咽神经阻滞,可明显降低小儿扁桃体切除术后的疼痛,减少术后发热的发生,减轻术后炎症反应,为小儿扁桃体切除术提供了一种有效的超前镇痛方法。

Objective:To observe the glossopharyngeal nerve block of low dose dexamethasone combined with ropivacaine hydrochloride on pain and inflammation in children after tonsillectomy.Methods:Eighty children with ASA gradeⅠ-Ⅱscheduled by pediatric tonsillectomy were randomly divided into two groups(40 cases in each group):ropivacaine group(Group L)and combination group(LD Group LD).The Group L was given 0.25%ropivacaine hydrochloride(2 mL),and the Group LD was given 0.25%ropivacaine hydrochloride combined with dexamethasone 0.1 mg/kg(2 mL).The FLACC scores,levels of inflammatory factors and incidence of adverse reactions at rest and during swallowing were recorded immediately after surgery,after 24 h and 48 h of surgery in two groups.Results:The FLACC score in the Group LD was lower than that in L group at 48 h after operation(P<0.05).The first feeding time of Group LD was earlier than that of Group L(P<0.01).The levels of C-reactive protein(CRP),interleukin(IL)-1βand IL-6 immediately and at 48 h after surgery in the Group LD were lower than those in Group L(P<0.05).The incidence of postoperative fever in the Group LD was lower than that in Group L(P<0.05).Conclusions:The glossopharyngeal nerve block of low dose dexamethasone combined with ropivacaine hydrochloride can obviously reduce the pain after tonsillectomy in children,occurrence of postoperative fever and postoperative inflammation,and provide an effective pre-analgesic method for children tonsillectomy.