改良胸腰筋膜阻滞用于小儿选择性神经根离断术术后镇痛效果研究

Analgesic effect of modified thoracolumbar interfascial plane block after selective dorsal rhizotomy in children

目的评价改良胸腰筋膜阻滞(M‑TLIP)对选择性脊神经根离断术(SDR)患儿的镇痛效果。方法选择全麻下行SDR的患儿65例,按随机数字表法分为切口浸润麻醉组(A组,32例)和改良胸腰筋膜阻滞组(B组,33例)。A组由术者于手术结束时给予0.375%罗哌卡因0.5 ml/kg切口浸润麻醉;B组由麻醉医师在全麻后手术开始前行超声引导下M‑TLIP,注射0.375%罗哌卡因0.5 ml/kg,术后采用电子静脉自控镇痛泵进行镇痛。记录两组患儿性别比,年龄,体重,手术时间,术中舒芬太尼及瑞芬太尼使用剂量,术后1、6、12、24、36、48 h儿童疼痛行为评估量表(FLACC)评分,术后镇痛泵按压次数,按压使用舒芬太尼总量,口服布洛芬混悬液总量和次数。使用广义估计方程(GEE)分析不同时间和不同镇痛方式对SDR患儿FLACC评分的影响。结果两组患儿性别比、年龄、体重、手术时间、术中舒芬太尼及瑞芬太尼使用剂量差异无统计学意义(均P>0.05);A组术后1、6、12、24、36、48 h FLACC评分高于B组(均P<0.05),且B组FLACC评分均≤3分;A组术后镇痛泵按压次数、按压使用舒芬太尼总量、口服布洛芬混悬液总量及次数高于B组(均P<0.05)。GEE模型f分析表明不同时间和不同镇痛方式对患儿FLACC评分的影响差异有统计学意义(均P<0.05)。结论M‑TLIP用于SDR患儿可提供更好的术后镇痛效果,减少术后镇痛药物的使用总量。

Objective To evaluate the effects of modified thoracolumbar interfascial plane block(M‑TLIP)on postoperative analgesia in children with lower limb dysfunction undergoing selective dorsal rhizotomy(SDR).Methods Sixty‑five children were selected for spinal nerve root dissection under general anesthesia.The children were divided into incisional infiltration group(group A,n=32)and modified thoracolumbar interfascial plane block group(group B,n=33)according to the random number table method.Group A received an incisional infiltration of 0.375%ropivacaine 0.5 ml/kg administered by the surgeon;in group B,an ultrasound‑guided modified thoracolumbar interfascial plane block was performed by the anesthesiologist after completion of anesthesia with an injection of 0.375%ropivacaine 0.5 ml/kg before the start of surgery,the electronic venous automatic analgesic pump was connected.The doctor re‑corded the general information(gender,age,weight),operation time,intraoperative doses of sufentanil and remifentanil,the postopera‑tive Face,Legs,Activity,Cry,and Controllability(FLACC)scores at 1,6,12,24,36 h and 48 h,the number of postoperative analgesic pump compressions,the dose of sufentanil used for compression,the dose and the numbers of oral ibuprofen suspensions.Generalized estimating equations(GEE)was used to analyze the effects of different time and different analgesia on FLACC score of SDR children.Results There was no statistically significant difference in sex ratio,age,weight,duration of surgery,intraoperative sufentanil and remifentanil use between the two groups of children(all P>0.05);in group A,the FLACC scores at 1,6,12,24,36 h,and 48 h after sur‑gery were higher than those in group B(all P<0.05),and the FLACC scores in group B were all≤3 points.The number of postoperative analgesic pump presses and the dose of sufentanil used to press were higher in group A compared with group B,the difference was sta‑tistically significant(all P<0.05).The number of postoperative oral ibuprofen suspensions and the dose were higher in group A than in group B,the difference was statistically significant(all P<0.05).GEE model analysis showed that different times and different analgesia methods had statistically significant effects on FLACC scores(all P<0.05).Conclusions The M‑TLIP for children with SDR pro‑vides better postoperative analgesia while reducing the dose of postoperative analgesics used in the children.