Department of Anesthesiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Lithuania.
J Pediatr Surg. 2013 Dec;48(12):2425-30. doi: 10.1016/j.jpedsurg.2013.08.016.
There are no published data regarding value of intercostal block following pectus excavatum repair. Our aim was to evaluate the efficacy of intercostal block in children following minimally invasive repair of pectus excavatum (MIRPE).
Forty-five patients given patient-controlled analgesia (PCA) with morphine postoperatively were studied. Twenty-six patients were given bilateral intercostal blocks after induction of anesthesia (PCA-IB group), and nineteen patients were retrospective controls without regional blockade (PCA group). All patients were followed up 24 h postoperatively.
A loading dose of morphine (0,1±0,49 mg/kg) before starting PCA was used in seventeen patients in PCA group vs. no patient in PCA-IB group. Cumulative used morphine doses were lower up to 12 h after surgery in PCA-IB group (0,29±0,08 μg/kg) than in the PCA group (0,46±0,18 μg/kg), p<0,01. There were no differences in pain scores, oxygen saturation values, sedation scores, and the incidence of pulmonary adverse events between the two groups. There was a tendency towards less morphine-related adverse effects in PCA-IB group compared to PCA group (p<0,05). No complications related to the intercostal blocks were observed.
Bilateral intercostal blocks following MIRPE are safe and easy to perform and can diminish postoperative opioid requirement. Double-blind randomized study is required to confirm the potential to diminish opioid related side effects.
目前尚无关于鸡胸矫正术后肋间阻滞效果的相关数据。我们旨在评估肋间阻滞在微创鸡胸矫正术（MIRPE）患儿中的应用效果。
对 45 例术后给予吗啡自控镇痛（PCA）的患者进行了研究。26 例患者在诱导麻醉后给予双侧肋间阻滞（PCA-IB 组），19 例患者为无区域阻滞的回顾性对照组（PCA 组）。所有患者术后均随访 24 小时。
PCA 组中有 17 例患者在开始 PCA 前使用吗啡负荷剂量（0.1±0.49mg/kg），而 PCA-IB 组中无患者使用。PCA-IB 组在术后 12 小时内累积使用吗啡剂量（0.29±0.08μg/kg）低于 PCA 组（0.46±0.18μg/kg），p<0.01。两组患者的疼痛评分、血氧饱和度值、镇静评分和肺部不良事件发生率无差异。与 PCA 组相比，PCA-IB 组吗啡相关不良反应的发生率有降低的趋势（p<0.05）。未观察到与肋间阻滞相关的并发症。
MIRPE 术后行双侧肋间阻滞安全且易于操作，可以减少术后阿片类药物的需求。需要进行双盲随机研究以证实其减少阿片类药物相关副作用的潜力。
