Bhattarai B K, Rahman T R, Sah B P, Tuladhar U R
Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Kathmandu Univ Med J (KUMJ). 2005 Jul-Sep;3(3):208-11.
To assess whether simplified ilioinguinal and iliohypogastric nerve block in combination with minimal wound infiltration with local anaesthetic is better than caudal block with local anaesthetic alone in children undergoing inguinal herniotomy for easy transition to safe oral analgesia.
Sixty children of both sexes undergoing herniotomy were allocated randomly to receive either simplified (single puncture) ilioinguinal and iliohypogastric nerve block described by Dalens in combination with small volume wound infiltration with 0.1 ml/kg of 0.25% bupivacaine (Group I) or caudal block with 1 ml/kg of 0.25% bupivacaine (Group II) at the end of surgery under general anaesthesia using halothane in oxygen and nitrous oxide mixture. Duration of analgesia, complication associated, parents and children's satisfaction were compared.
The mean duration of analgesia was 253+/-102.6 minutes in group I as compared to 219.6+/-48.4 minutes in group II. Six (20%) patients in group I and two (6.67%) patients in group II required parenteral analgesic. Complications and parents and children's satisfaction were comparable in both the groups.
Simplified ilioinguinal and iliohypogastric nerve blocks described by Dalens in combination with small volume local anaesthetic wound infiltration with its longer mean duration of analgesia offers better safety margin to start oral analgesics than caudal block with local anaesthetic alone in children undergoing herniotomy. Larger studies may further confirm the findings.
评估在接受腹股沟疝修补术的儿童中，简化的髂腹股沟和髂腹下神经阻滞联合小剂量局部麻醉药伤口浸润，是否比单纯使用局部麻醉药的骶管阻滞更有利于向安全的口服镇痛平稳过渡。
60例接受疝修补术的儿童，随机分为两组，一组在全身麻醉（使用氧气、氧化亚氮和氟烷混合气体）结束时，接受Dalens描述的简化（单穿刺）髂腹股沟和髂腹下神经阻滞，并联合0.1 ml/kg的0.25%布比卡因进行小剂量伤口浸润（I组）；另一组接受1 ml/kg的0.25%布比卡因骶管阻滞（II组）。比较两组的镇痛持续时间、相关并发症、家长及患儿的满意度。
I组的平均镇痛持续时间为253±102.6分钟，II组为219.6±48.4分钟。I组有6例（20%）患者和II组有2例（6.67%）患者需要注射镇痛药物。两组的并发症、家长及患儿的满意度相当。
Dalens描述的简化髂腹股沟和髂腹下神经阻滞联合小剂量局部麻醉药伤口浸润，其平均镇痛持续时间更长，与单纯使用局部麻醉药的骶管阻滞相比，为接受疝修补术的儿童开始口服镇痛提供了更好的安全边际。更大规模的研究可能会进一步证实这些发现。
