Palmer G M, Luk V H Y, Smith K R, Prentice E K
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.
Anaesth Intensive Care. 2011 Mar;39(2):279-86. doi: 10.1177/0310057X1103900220.
The extent of dermatomal block post transversus abdominis plane block is described in adults as T7-L1; other authors argue extent above T10 is infrequent (supra-iliac 20 ml injection). A paediatric guideline recommends this block for upper and lower abdominal surgery using 0.2 ml/kg. We aimed (through prospective audit) to document the multi-level block achieved with ultrasound-guided transversus abdominis plane block in children having abdominal surgery, during a departmental training period. Data included patient, anaesthetic and surgical details, transversus abdominis plane block characteristics (anterior supra-iliac injections) and dermatomal blockade to ice. Twenty-seven children received 38 blocks performed by 58% consultant and 42% trainee operators (90% novices): 16 unilateral/11 bilateral for umbilical (1), inguinal (13), laparoscopic (8) and laparotomy (5) surgery. Dermatomal assessment for 35 blocks (mean local anaesthetic volume 0.4 ml/kg [SD 0.2]) revealed the median blockade achieved was 3 dermatomes (interquartile range 3 to 4) involving T10 to L1 in 75% of patients. Eight blocks (six patients) also involved T8 and T9, following 0.31 to 0.81 ml/kg. One patient (3% of assessed blocks) had no block to ice at 60 minutes, but required no postoperative analgesia. Ultrasound-guided transversus abdominis plane blocks performed by supra-iliac approach and novice operators produced lower abdominal sensory blockade in children of usually 3 to 4 dermatomes, and should be offered for lower abdominal surgery only, as only 25% had upper abdominal block extension. The optimal local anaesthetic dose/volume, duration of effect and utility for these blocks in relation to peripheral and neuraxial blockade needs clarification.
成人经腹横肌平面阻滞术后皮节阻滞范围描述为T7-L1；其他作者认为T10以上范围较少见（髂前上棘处注射20毫升）。一份儿科指南推荐在上下腹部手术中使用经腹横肌平面阻滞，剂量为0.2毫升/千克。我们旨在（通过前瞻性审计）记录在科室培训期间接受腹部手术的儿童中，超声引导下经腹横肌平面阻滞所实现的多节段阻滞情况。数据包括患者、麻醉和手术细节、经腹横肌平面阻滞特征（髂前上棘前注射）以及对冰敷的皮节阻滞情况。27名儿童接受了38次阻滞，由58%的顾问医生和42%的实习医生（90%为新手）操作：16次单侧/11次双侧，用于脐部（1例）、腹股沟（13例）、腹腔镜（8例）和剖腹手术（5例）。对35次阻滞（平均局部麻醉药剂量0.4毫升/千克[标准差0.2]）的皮节评估显示，实现的中位阻滞为3个皮节（四分位间距3至4），75%的患者涉及T10至L1。8次阻滞（6名患者）在注射0.31至0.81毫升/千克后还涉及T8和T9。1名患者（占评估阻滞的3%）在60分钟时对冰敷无阻滞，但无需术后镇痛。通过髂前上棘入路和新手操作者进行的超声引导下经腹横肌平面阻滞，在儿童中产生的下腹部感觉阻滞通常为3至4个皮节，仅应提供给下腹部手术，因为只有25%的患者有上腹部阻滞扩展。这些阻滞相对于外周和神经轴阻滞的最佳局部麻醉药剂量/体积、作用持续时间及效用尚需明确。
