Mesnil Malcie, Dadure Christophe, Captier Guillaume, Raux Olivier, Rochette Alain, Canaud Nancy, Sauter Magali, Capdevila Xavier
Department of Anaesthesiology and Intensive Care A, Lapeyronie University Hospital, F-34925 Montpellier, France.
Paediatr Anaesth. 2010 Apr;20(4):343-9. doi: 10.1111/j.1460-9592.2010.03262.x. Epub 2010 Feb 23.
Congenital cleft palate (CP) is a common and painful surgical procedure in infants. CP repair is associated with the risk of postoperative airway obstruction, which may be increased with administration of opioids, often needed for analgesia. No described regional anesthesia technique can provide adequate pain control following CP repair in infants. The primary aim of this prospective and descriptive study was to observe the effectiveness of bilateral maxillary nerve blocks (BMB) using a suprazygomatic approach on pain relief and consumption of rescue analgesics following CP repair in infants. Analgesic consumption was compared to retrospective data. Complications related to this new technique in infants were also reviewed.
The landmarks and measurements recently defined in a three-dimensional study using computed tomography in infants were used. After general anesthesia, a BMB was performed bilaterally with 0.15 ml x kg(-1) 0.2% ropivacaine in infants scheduled for CP repair. Postoperative analgesia, administration of rescue analgesics, adverse effects, and time to feed were recorded in the 48-h period following surgery and compared to retrospective data.
Thirty-three children, mean age 5 +/- 1.8 months and weight 8.3 +/- 1.2 kg, were studied. Eighteen patients out of 33 (55%) did not require additional opioids intra-operatively, vs two out of 20 (10%) without block. None needed morphine postoperatively, and intravenous nalbuphine was required in only six children (18%), vs 16 (80%) without block. Median time to feed was 8 h (range 2-24 h), vs 13 h (4-25) without block. No technical failure or complication related to the BMB was reported.
BMB using a suprazygomatic approach seems to improve pain relief, to decrease peri-operative consumption of opioids, and to favor early feeding resumption after CP repair in infants.
先天性腭裂（CP）修复术是婴儿常见且痛苦的外科手术。腭裂修复术与术后气道阻塞风险相关，而用于镇痛的阿片类药物可能会增加这种风险。目前尚无描述的区域麻醉技术能在婴儿腭裂修复术后提供足够的疼痛控制。这项前瞻性描述性研究的主要目的是观察采用颧上入路的双侧上颌神经阻滞（BMB）对婴儿腭裂修复术后疼痛缓解及急救镇痛药使用的效果。将镇痛药使用情况与回顾性数据进行比较。还对婴儿中与这项新技术相关的并发症进行了评估。
采用婴儿计算机断层扫描三维研究中最近确定的标志点和测量方法。在全身麻醉后，对计划进行腭裂修复术的婴儿双侧注射0.15 ml/kg⁻¹的0.2%罗哌卡因进行双侧上颌神经阻滞。记录术后48小时内的术后镇痛、急救镇痛药的使用、不良反应及开始进食时间，并与回顾性数据进行比较。
共研究了33名儿童，平均年龄5±1.8个月，体重8.3±1.2 kg。33名患者中有18名（55%）术中无需额外使用阿片类药物，而未行阻滞的20名患者中有2名（10%）无需额外使用。术后无一例需要吗啡，仅6名儿童（18%）需要静脉注射纳布啡，而未行阻滞的为16名（80%）。开始进食的中位时间为8小时（范围2 - 24小时），未行阻滞的为13小时（4 - 25小时）。未报告与双侧上颌神经阻滞相关的技术失败或并发症。
采用颧上入路的双侧上颌神经阻滞似乎能改善疼痛缓解，减少围手术期阿片类药物的使用，并有利于婴儿腭裂修复术后尽早恢复进食。
