地塞米松+罗哌卡因髂筋膜神经阻滞联合全麻在小儿先天性髋关节脱位矫形术中的效果分析

Study on the effect of dexamethasone and ropivacaine iliac fascia nerve block combined with general anesthesia in corrective surgery for congenital hip dislocation in children

目的评价地塞米松+罗哌卡因髂筋膜神经阻滞用于小儿先天性髋关节脱位矫形手术围手术期的镇痛效果。方法选择2019年2月—2022年8月于郑州市骨科医院行先天性髋关节脱位矫形术的患儿90例,采用随机数字表法分为3组:全麻组(C组,30例)、罗哌卡因-全麻组(L组,30例)和地塞米松+罗哌卡因-全麻组(D组,30例)。全麻后,L组超声引导下注射0.25%罗哌卡因1 mL/kg。D组超声引导下注射0.2 mg/kg地塞米松+0.25%罗哌卡因1 mL/kg。术后疼痛采用酮咯酸氨丁三醇、氢吗啡酮补救。记录3组患儿术中麻醉药物用量和苏醒情况,术后痛觉阻滞时间、补救药物应用情况。结果与C组丙泊酚和瑞芬太尼用量[(336±35)mg、(383±35)μg]比较,L组[(197±28)mg、(188±22)μg]和D组[(194±32)mg、(187±28)μg]均减少(P<0.001);L组和D组苏醒时间、拔管时间、麻醉恢复室停留时间均缩短(P<0.001)。C组[(27.5±11.2)min]、L组[(357.4±102.7)min]术后痛觉阻滞时间均短于D组[(485.2±120.6)min,P<0.001]。D组、L组术后氢吗啡酮使用率均低于C组(P<0.001);D组恶心呕吐发生率低于C组、L组(P<0.017)。结论地塞米松+罗哌卡因腹股沟上髂筋膜阻滞联合全麻用于小儿先天性髋关节脱位矫形手术,痛觉阻滞时间延长,抑制了围手术期痛敏反应,利于实现围手术期舒适化医疗。

Objective To assess the analgesic efficacy of dexamethasone combined with ropivacaine iliac fascial nerve block in pediatric patients undergoing orthopedic surgery for congenital hip dislocation.Methods Ninety children who underwent corrective surgery for congenital hip dislocation at Zhengzhou Orthopedic Hospital from February 2019 to August 2022 were selected and divide into three groups(n=30)using a random number table:general anesthesia group(Group C),ropivacaine general anesthesia group(Group L),and dexamethasone+ropivacaine general anesthesia group(Group D).After general anesthesia,group L received an injection of 0.25%ropivacaine 1 mL/kg under ultrasound guidance.Group D received an injection of 0.2 mg/kg dexamethasone and 0.25%ropivacaine 1 mL/kg under ultrasound guidance.Postoperative pain was managed with ketorolac tromethamine and hydromorphone.The dosage and awakening status of anesthesia drugs during surgery,postoperative pain blockade time,and application of remedial drugs were recorded for the three groups of pediatric patients.Results Compared to the dosage of propofol and remifentanil in Group C[(336±35)mg,(383±35)μg],the dosages in the Group L[(197±28)mg,(188±22)μg]and group D[(194±32)mg,(187±28)μg]were significantly reduced(P<0.001).The awakening time,extubation time,and post-anesthesia care unit residence time were also shortened(P<0.001).The postoperative pain blockade time in Group C[(27.5±11.2)min]and Group L[(357.4±102.7)min]was shorter than that in Group D[(485.2±120.6)min,P<0.001].The postoperative use rate of hydromorphone in Group D was lower than that in Group C and Group L(P<0.001).Additionally,the incidence of nausea and vomiting in Group D was lower than that in Group C and Group L(P<0.017).Conclusion The combination of dexamethasone and ropivacaine in a supra-inguinal fascia iliaca block with general anesthesia is used in the correction surgery for congenital hip dislocation in children.This approach prolongs pain blockade time and suppresses perioperative pain sensitivity reactions,contributing to more comfortable perioperative medical care.