Dadure Christophe, Bringuier Sophie, Nicolas Florence, Bromilow Luke, Raux Olivier, Rochette Alain, Capdevila Xavier
Department of Anesthesia, Lapeyronie University Hospital, Montpellier, France.
Anesth Analg. 2006 Mar;102(3):744-9. doi: 10.1213/01.ane.0000195439.54650.dc.
Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. In this prospective, randomized study we evaluated the effectiveness and adverse events of CPNB or CEB in children after podiatric surgery. Fifty-two children scheduled for foot surgery were separated into four groups by age and analgesia technique. After general anesthesia, 0.5 to 1 mL/kg of an equal-volume mixture of 0.25% bupivacaine and 1% lidocaine with 1:200000 epinephrine was injected via epidural or popliteal catheters. In the postoperative period, 0.1 mL x kg(-1) x h(-1) (group CPNB) or 0.2 mL x kg(-1) x h(-1) (group CEB) of 0.2% ropivacaine was administered for 48 h. Niflumic acid was routinely used. Adverse events were noted in each treatment group. Postoperative pain during motion was evaluated at 1, 6, 12, 18, 24, 36, and 48 h. Requirement for rescue analgesia (first-line propacetamol 30 mg/kg 4 times daily or second-line 0.2 mg/kg IV nalbuphine), and motor blockade were recorded. Parental satisfaction was noted at 48 h. Twenty-seven patients were included in the CEB groups and 25 in CPNB groups. There were 32 children 1 to 6 yr of age (CPNB = 15; CEB = 17) and 20 children 7 to 12 yr of age (CPNB = 10; CEB = 10). The demographic data were comparable among groups. Postoperative analgesia was excellent for the two continuous block techniques and in the two age groups. Motor block intensity was equal between techniques. Adverse events (postoperative nausea or vomiting, urinary retention, and premature discontinuation of local anesthetic infusion in the 1- to 6-yr-old group) were significantly more frequent in the CEB group (P < 0.05). Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent postoperative analgesia in this study, CPNB was associated with less urinary retention and nausea and vomiting. Therefore, we recommend CPNB as the ideal form of postoperative analgesia after major podiatric surgery in 1- to 12-yr-old children.
儿童足踝手术后疼痛剧烈。阿片类药物和连续硬膜外阻滞（CEB）的不良反应限制了它们在儿童中的应用。连续腘窝神经阻滞（CPNB）在儿童中的该适应证尚未得到研究。在这项前瞻性随机研究中，我们评估了CPNB或CEB在儿童足部手术后的有效性和不良事件。52例计划进行足部手术的儿童按年龄和镇痛技术分为四组。全身麻醉后，通过硬膜外或腘窝导管注射0.5至1 mL/kg的0.25%布比卡因和1%利多卡因与1:200000肾上腺素的等体积混合液。术后48小时，以0.1 mL·kg⁻¹·h⁻¹（CPNB组）或0.2 mL·kg⁻¹·h⁻¹（CEB组）的剂量给予0.2%罗哌卡因。常规使用尼氟酸。记录每个治疗组的不良事件。在术后1、6、12、18、24、36和48小时评估活动时的术后疼痛。记录补救性镇痛的需求（一线药物对乙酰氨基酚30 mg/kg，每日4次，或二线药物静脉注射纳布啡0.2 mg/kg）以及运动阻滞情况。在48小时记录家长满意度。CEB组纳入27例患者，CPNB组纳入25例患者。有32例1至6岁的儿童（CPNB组 = 15例；CEB组 = 17例）和20例7至12岁的儿童（CPNB组 = 10例；CEB组 = 10例）。各组间人口统计学数据具有可比性。两种连续阻滞技术以及两个年龄组的术后镇痛效果均极佳。两种技术的运动阻滞强度相当。不良事件（术后恶心或呕吐、尿潴留以及1至6岁组局部麻醉药输注过早中断）在CEB组更为常见（P < 0.05）。CEB组86%的家长和CPNB组100%的家长表示满意。我们得出结论，尽管在本研究中CEB和CPNB均产生了极佳的术后镇痛效果，但CPNB导致的尿潴留以及恶心和呕吐较少。因此，我们推荐CPNB作为1至12岁儿童足部大手术后理想的术后镇痛方式。
