Bussolin Leonardo, Busoni Paolo, Giorgi Letizia, Crescioli Massimo, Messeri Andrea
Department of Anesthesiology, and Intensive Care, Meyer Children's Hospital, Florence, Italy.
Anesthesiology. 2003 Dec;99(6):1371-5. doi: 10.1097/00000542-200312000-00020.
Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients.
In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed.
No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment.
Tumescent local anesthesia with maximum dose of 7 mg/kg lidocaine seems to be safe and the sole possible effective locoregional anesthesia technique for the surgical treatment of noncontiguous pediatric burns.
肿胀局麻是一种通过大量注射局部麻醉剂来对皮肤和皮下组织进行区域麻醉的技术。该技术的优点包括：（1）操作简单；（2）术后镇痛时间长；（3）出血发生率低；（4）可麻醉身体大面积区域。目前尚无关于在儿科患者中使用肿胀局麻的报道。
连续选取30例年龄在1至120个月（平均34±31.6个月）、美国麻醉医师协会身体状况分级为I或II级的儿科烧伤患者，在氧化亚氮-氧气-七氟醚诱导麻醉后，分别用0.05%（14 ml/kg）或0.1%（7 ml/kg）利多卡因溶液进行浸润麻醉。麻醉维持采用患者自主呼吸，吸入含1.5%七氟醚的氧化亚氮-氧气（50%）混合气体。利多卡因的最大使用剂量为7 mg/kg。术后疼痛采用安大略东部儿童医院疼痛量表（用于5岁及以下患者）和视觉模拟量表（用于5岁以上患者）进行评估。并与未采用肿胀局麻技术的历史对照组进行比较。
无患者被排除在研究之外，术中监测参数未见明显变化。5例患者在手术开始时心率和呼吸频率增加，其中2例需要临时增加七氟醚浓度。初次切开后，未观察到对疼痛刺激的反应。未发生并发症。6例患者术后需要使用对乙酰氨基酚，24例患者无需镇痛治疗。
最大剂量为7 mg/kg利多卡因的肿胀局麻似乎是安全的，并且是小儿非连续性烧伤手术治疗唯一可能有效的局部区域麻醉技术。
