局部麻醉对儿童全身麻醉下牙齿修复后恢复特征质量的影响。

The effect of local anesthetic on quality of recovery characteristics following dental rehabilitation under general anesthesia in children.

作者信息

Townsend Janice A, Ganzberg Steven, Thikkurissy S

机构信息

LSU School of Dentistry, Department of Pediatric Dentistry, New Orleans, Louisiana 70119, USA.

出版信息

Anesth Prog. 2009 Winter;56(4):115-22. doi: 10.2344/0003-3006-56.4.115.

Abstract

This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug (NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA). Twenty-seven healthy children aged 3-5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3-5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4-6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3-5.5 years.

摘要

本研究是一项随机、前瞻性、双盲研究,旨在评估局部麻醉药与静脉注射非甾体抗炎药(NSAID)联合使用与单独使用NSAID对全身麻醉(GA)下牙齿修复后恢复质量的影响。27名年龄在3至5.5岁的健康儿童接受了GA下的牙齿修复。实验组的15名儿童除静脉注射酮咯酸氨丁三醇外,还接受了局部麻醉药的口腔浸润,而对照组的12名儿童仅接受静脉注射酮咯酸氨丁三醇用于术后疼痛管理。术后立即使用FLACC量表评估疼痛行为,并在术后4小时通过使用各种量表进行自我报告评估。家长报告了对儿童疼痛和舒适度的感知以及术后咬脸颊的任何情况。对于3至5.5岁儿童在全身麻醉下进行完整牙齿修复使用口腔浸润局部麻醉,在麻醉后护理单元(PACU)中并未改善疼痛行为,在术后4至6小时通过FLACC量表、面部表情量表以及家长或PACU护士的主观报告测量也未改善疼痛行为。那些接受局部麻醉的儿童与局部麻醉药给药相关的负面症状发生率较高,包括咬唇和咬脸颊的发生率较高,这具有临床重要性,但无统计学意义。全身麻醉下牙齿修复时局部麻醉药的浸润并未改善3至5.5岁儿童的恢复质量。

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