较低浓度罗哌卡因用于超声引导下神经阻滞在儿童骨科手术中的效果观察

Effects of lower concentrations of ropivacaine on ultrasound-guided nerve block in pediatric orthopedic surgery

目的探究较低浓度的罗哌卡因用于超声引导下神经阻滞在儿童骨科手术中的效果。方法回顾性选取2023年5月至2024年2月于苏州市吴江区儿童医院骨科手术的患儿75例,按罗哌卡因使用浓度不同分为三组,其中A组25例,采用0.15%罗哌卡因神经阻滞;B组25例,采用0.20%罗哌卡因神经阻滞;C组25例,采用0.25%罗哌卡因神经阻滞。观察比较超声引导下三种不同浓度罗哌卡因神经阻滞后患儿麻醉前后心率、平均动脉压,麻醉起效时间,镇痛维持时间,运动和感觉功能恢复时间,以及术后2 h的儿童疼痛行为量表(FLACC)评分,术后局部麻醉药物不良反应的发生率。结果三组患儿心率、平均动脉压的体征指标比较差异无统计学意义(P>0.05);随着罗哌卡因浓度升高,患儿麻醉起效时间缩短[(11.04±1.02)min比(10.44±1.04)、(7.16±0.85)min],三组比较差异均有统计学意义(P<0.05);三组患儿镇痛维持时间比较差异无统计学意义(P>0.05);随着罗哌卡因浓度升高,患儿运动及感觉功能恢复时间延长[(194.64±20.43)min比(207.72±22.34)和(250.32±30.18)min;(176.44±16.18)min比(189.24±20.66)和(224.08±29.56)min],三组比较差异均有统计学意义(P<0.05);三组患儿术后2 h FLACC评分差异无统计学意义(P>0.05);A组不良反应总发生率低于B、C组[4%(1/25)比24%(6/25)和52%(13/25)],三组比较差异均有统计学意义(P<0.05)。结论0.15%的罗哌卡因用于超声引导下神经阻滞在儿童骨科手术中能够达到较好麻醉效果,不良反应发生率低,值得临床推广。

Objective To explore the effects of lower concentrations of ropivacaine on ultrasound-guided nerve block in pediatric orthopedic surgery.Methods Using a retrospective study method,75 children who underwent orthopedic surgery at Wu Jiang District Children′s Hospital from May 2023 to February 2024 were selected and divided into Group A(25 cases,0.15%ropivacaine nerve block),Group B(25 cases,0.20%ropivacaine nerve block)and Group C(25 cases,0.25%ropivacaine nerve block).The heart rate;mean arterial pressure;onset time of anesthesia;analgesic maintenance time;recovery time of movement and sensation;child face,legs,activity,cry,consolability behavioral tool(FLACC)score at 2 h after surgery;adverse reactions incidence of postoperative local anesthetic drugs were compared.Results There was no statistically significant difference in the physical indicators of heart rate and mean arterial pressure among the three groups(P>0.05).As the concentration of ropivacaine increased,the onset time of anesthesia in the three groups of children was shortened:(11.04±1.02)vs.(10.44±1.04)and(7.16±0.85)min,and the differences between the three groups were statistically significant(P<0.05);There was no statistically significant difference in the analgesic maintenance time among the three groups(P>0.05).As the concentration of ropivacaine increased,the recovery time of movement and sensation was increased:(194.64±20.43)min vs.(207.72±22.34)and(250.32±30.18)min,(176.44±16.18)min vs.(189.24±20.66)and(224.08±29.56)min,and the differences among the three groups were statistically significant(P<0.05).There was no statistically significant difference in FLACC scores among the three groups of patients at 2 h after surgery(P>0.05).The total incidence of adverse reactions in Group A was lower than that in Groups B and C:4%(1/25)vs.24%(6/25)and 52%(13/25),and the differences among the three groups were statistically significant(P<0.05).Conclusions The 0.15%ropivacaine used for ultrasound-guided nerve block in pediatric orthopedic surgery can achieve good anesthesia effects with low incidence of adverse reactions,and is worthy of clinical promotion.