Tug R, Ozcengiz D, Güneş Y
Department of Anesthesiology, Cukurova University Medical Faculty, Balcali-Adana, Turkey.
Anaesth Intensive Care. 2011 Sep;39(5):909-13. doi: 10.1177/0310057X1103900517.
Paravertebral block (PVB) has been used for postoperative analgesia in children since 1992. There are no prospective randomised studies comparing the use of PVB versus caudal block (CB) for outpatient inguinal hernia repair surgery. The hypothesis of this study is that a single level, single injection PVB can provide a longer duration of analgesia and less requirement for supplemental analgesia than single shot CB for children undergoing inguinal surgery. Seventy children, aged three to seven, American Society of Anesthesiologists score I to II, having unilateral inguinal surgery were enrolled in the study. The patients were divided into two randomised groups. In group PVB, a single shot of 0.2 ml/kg levobupivacaine was administered via the lumbar paravertebral route and in group CB, patients were given 1 ml/kg levobupivacaine caudally. Sevoflurane concentration was evaluated after induction and recorded during incision, sac traction and closure. Face, legs, activity, cry and consolability (FLACC) scores, heart rate, blood pressure and SpO2 were evaluated postoperatively. Only four (11.4%) patients in the PVB group needed rescue analgesic drugs compared to 12 (34.3%) patients in the CB group (P = 0.044). Patients were given tramadol as rescue analgesia in the first four postoperative hours. No other supplemental analgesic drug was given apart from tramadol. FLACC scores were the same in the both groups. Parental satisfaction was significantly higher in the PVB group compared to the CB group (74.3 vs 40%, P = 0.01). This study has demonstrated that a single level single injection paravertebral block provides superior intraoperative and postoperative analgesia when compared to a caudal block for unilateral inguinal hernia repair.
自1992年以来，椎旁阻滞（PVB）已用于儿童术后镇痛。目前尚无前瞻性随机研究比较PVB与骶管阻滞（CB）用于门诊腹股沟疝修补手术的情况。本研究的假设是，对于接受腹股沟手术的儿童，单次、单节段PVB比单次骶管阻滞能提供更长时间的镇痛，且对辅助镇痛的需求更少。70例年龄在3至7岁、美国麻醉医师协会分级为I至II级、接受单侧腹股沟手术的儿童纳入本研究。患者被随机分为两组。PVB组经腰椎旁途径注射0.2 ml/kg左旋布比卡因，CB组经骶管给予1 ml/kg左旋布比卡因。诱导后评估七氟醚浓度，并在切口、疝囊牵拉和关闭过程中记录。术后评估面部、腿部、活动、哭闹及安慰情况（FLACC）评分、心率、血压和血氧饱和度。PVB组仅4例（11.4%）患者需要补救性镇痛药，而CB组为12例（34.3%）患者（P = 0.044）。术后前4小时给予患者曲马多作为补救性镇痛。除曲马多外，未给予其他辅助镇痛药。两组的FLACC评分相同。PVB组家长满意度显著高于CB组（74.3%对40%，P = 0.01）。本研究表明，对于单侧腹股沟疝修补术，单次、单节段椎旁阻滞比骶管阻滞提供更好的术中和术后镇痛效果。
