Department of Anesthesiology, Federal University of Juiz de Fora, Brazil.
J Pediatr Urol. 2013 Oct;9(5):638-42. doi: 10.1016/j.jpurol.2012.07.013. Epub 2012 Aug 13.
To evaluate whether dorsal penile nerve block (DPNB) or local topical anesthesia (LT) provided better postoperative analgesia and less hemodynamic stimulation during and after circumcision surgery with Plastibell in older children.
Forty-one subjects (age: 2-13 years) undergoing circumcision with Plastibell were randomly divided into LT and DPNB groups. Inhalation induction was performed with an 8% end-tidal sevoflurane concentration. In the LT group, a eutectic ointment of 5% lidocaine and 5% prilocaine was applied to the foreskin 1 h before surgery. At 10 min after anesthesia induction, the end-tidal sevoflurane concentration was decreased to 2%. In the other group, a DPNB was performed with 0.5% bupivacaine (1 mg/kg). Heart rate (HR), respiratory rate, mean arterial pressure (MAP), and involuntary movements were evaluated at anesthesia induction (T0), 1 min after DPNB (T1), 1 min after incision (T2), and 1 min after surgery (T3). Pain was evaluated at 1 and 24 h after surgery, and complications were evaluated at 24 h after surgery.
The groups were homogeneous with respect to age, weight, glans diameter, penile length, Kayaba classification, and surgical duration. The LT group showed increased HR (p = 0.073) and MAP (p = 0.046) at T2 as compared to T0. No hemodynamic changes were observed in the HPDB group. The LT group showed a higher pain score at 1 h after surgery than the DPNB group, whereas the DPNB group had a higher incidence of hematoma (p = 0.02) at 24 h after surgery.
Anesthesia with 5% lidocaine and 5% prilocaine cream during circumcision of older children with Plastibell under general anesthesia with sevoflurane does not provide satisfactory perioperative hemodynamic stability or postoperative analgesia.
评估在全身麻醉下使用七氟醚对 2-13 岁儿童行 Plastibell 包皮环切术时，阴茎背神经阻滞（DPNB）或局部表面麻醉（LT）在术后镇痛和减少术中及术后血流动力学刺激方面的效果。
41 例（年龄：2-13 岁）行 Plastibell 包皮环切术的患者随机分为 LT 组和 DPNB 组。吸入诱导采用 8%七氟醚的呼气末浓度。LT 组在术前 1 小时将 5%利多卡因和 5%丙胺卡因的共晶混合物软膏涂于包皮。麻醉诱导后 10 分钟，将呼气末七氟醚浓度降至 2%。另一组在 DPNB 中使用 0.5%布比卡因（1mg/kg）。在麻醉诱导时（T0）、DPNB 后 1 分钟（T1）、切口后 1 分钟（T2）和手术后 1 分钟（T3）评估心率（HR）、呼吸频率、平均动脉压（MAP）和不自主运动。术后 1 小时和 24 小时评估疼痛，术后 24 小时评估并发症。
两组在年龄、体重、龟头直径、阴茎长度、Kayaba 分类和手术时间方面具有可比性。与 T0 相比，LT 组在 T2 时 HR（p=0.073）和 MAP（p=0.046）升高。DPNB 组未观察到血流动力学变化。LT 组在术后 1 小时的疼痛评分高于 DPNB 组，而 DPNB 组在术后 24 小时的血肿发生率更高（p=0.02）。
在全身麻醉下使用七氟醚对 2-13 岁儿童行 Plastibell 包皮环切术时，使用 5%利多卡因和 5%丙胺卡因乳膏进行麻醉并不能提供满意的围手术期血流动力学稳定性或术后镇痛。
