Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2012 Jan;59(1):28-33. doi: 10.1007/s12630-011-9607-2. Epub 2011 Nov 10.
In an effort to decrease postoperative opioid requirements, intraoperative bilateral superficial cervical plexus block (BSCPB) was recently adopted for all our children undergoing general anesthesia for bilateral simultaneous cochlear implantation (BSiCI). Several cases of early postoperative fever were noted after the adoption of BSCPB. Our aim was to determine if an association exists between BSCPB and early postoperative fever in children undergoing BSiCI. As a secondary outcome, we studied the efficacy of BSCPB in altering postoperative analgesic requirements.
We conducted a retrospective cohort study of 91 consecutive children who underwent BSiCI. The series included 34 patients who received BSCPB (Block Group) and 57 patients who did not receive BSCPB (No-block Group).
The median age (range) was 15.4 months (eight months - 15 yr). A significant association was found between BSCPB and postoperative fever (P = 0.006). Eighteen (19.7%) children developed fever in the first 24 hr after surgery (Block Group: 12/34 [35%]; No-block Group: 6/57 [11%]; P = 0.006). The Block Group was 4.8 times more likely to develop early postoperative fever after adjusting for other variables (P = 0.004). The Block Group spent more days in hospital after surgery compared with the No-block Group (P = 0.043). Other vital signs showed no major deviation from the normal ranges, and daily physical examinations revealed no obvious source of infection in children who developed postoperative fever.
Bilateral superficial cervical plexus block may increase the risk of postoperative fever in children undergoing BSiCI. In this series, BSCPB was associated with a longer hospital admission. The etiology of the fever is undetermined, although it can be hypothesized that BSCPB resulted in unintended block of the phrenic nerves leading to diaphragmatic paralysis, atelectasis, and early postoperative fever in young children.
为了减少术后阿片类药物的需求，最近我们为所有接受全身麻醉双侧同期人工耳蜗植入术（BSiCI）的儿童采用了术中双侧颈浅丛阻滞（BSCPB）。采用 BSCPB 后，我们注意到几例术后早期发热。我们的目的是确定 BSCPB 是否与接受 BSiCI 的儿童术后早期发热有关。作为次要结果，我们研究了 BSCPB 改变术后镇痛需求的效果。
我们对 91 例连续接受 BSiCI 的儿童进行了回顾性队列研究。该系列包括 34 例接受 BSCPB（阻滞组）和 57 例未接受 BSCPB（无阻滞组）的患者。
中位年龄（范围）为 15.4 个月（8 个月-15 岁）。BSCPB 与术后发热之间存在显著相关性（P=0.006）。18 例（19.7%）儿童在术后 24 小时内出现发热（阻滞组：12/34 [35%]；无阻滞组：6/57 [11%]；P=0.006）。调整其他变量后，阻滞组发生早期术后发热的可能性是无阻滞组的 4.8 倍（P=0.004）。与无阻滞组相比，阻滞组术后住院天数更多（P=0.043）。其他生命体征无明显偏离正常范围，发热儿童每日体格检查未发现明显感染源。
双侧颈浅丛阻滞可能会增加接受 BSiCI 的儿童术后发热的风险。在本系列中，BSCPB 与住院时间延长有关。发热的病因尚不确定，尽管可以假设 BSCPB 导致意外阻滞膈神经，导致小儿膈肌麻痹、肺不张和术后早期发热。
