Sola Chrystelle, Menace Cecilia, Rochette Alain, Raux Olivier, Bringuier Sophie, Molinari Nicolas, Kalfa Nicolas, Capdevila Xavier, Dadure Christophe
From the Department of Anaesthesia and Critical Care Medicine, Lapeyronie University Hospital (CS, CM, AR, OR, SB, XC, CD), Department of Biostatistics, Epidemiology and Medical Information, La Colombière University Hospital (SB, NM), and Department of Abdominal and Urological Surgery, Lapeyronie University Hospital, Montpellier, France (NK).
Eur J Anaesthesiol. 2014 Jun;31(6):327-32. doi: 10.1097/EJA.0000000000000040.
Regional anaesthesic techniques are commonly used for the management of pain following lower abdominal surgery in children. The transversus abdominis plane (TAP) block has shown promise for perioperative analgesia, but data on the optimal dose regimen are limited.
To evaluate the optimal dose of levobupivacaine for successful ultrasound-guided TAP block in children.
A dose finding prospective study using Dixon's up-and-down sequential method.
University Hospital Paediatric Anaesthesia Unit.
Twenty-seven consecutive children aged 1 to 5 years scheduled for day-case elective herniorrhaphy.
After standardised induction of general anaesthesia, ultrasound-guided TAP block was performed with a fixed volume of 0.2 ml kg(-1) of levobupivacaine solution. The dose of levobupivacaine was determined by Dixon's up-and-down method starting from 0.5 mg kg(-1)with an interval of 0.1 mg kg(-1). Block failure was defined as a 20% increase in heart rate or mean arterial pressure from baseline. Rescue analgesia consisted of intravenous remifentanil infusion during surgery and intravenous nalbuphine in the postanaesthetic care unit (PACU). Patients were assessed using the FLACC (face, legs, activity, cry and consolability) pain scale, the rescue analgesic consumption in the PACU and day-case unit and the postoperative pain measure for parents score at home.
The mean effective dose of levobupivacaine resulting in an effective TAP block in 50% of cases (ED50) obtained by using Dixon's up-and-down sequential method. The ED50 and ED95 were further estimated by bootstrapping.
The ED50 according to the up-and-down staircase method was 0.22 mg kg(-1) [95% confidence interval (CI) 0.19 to 0.25]. Bootstrap replicates of the original dataset resulted in ED50 and ED95 estimates of 0.16 mg kg(-1) (95% CI 0.11 to 0.24) and 0.43 mg kg(-1)(95% CI 0.30 to 0.57), respectively.
As part of a multimodal analgesia strategy, ultrasound-guided TAP block with 0.2 ml kg(-1)of 0.2% levobupivacaine provides successful peroperative analgesia in 95% of children who underwent herniorrhaphy.
区域麻醉技术常用于小儿下腹部手术后的疼痛管理。腹横肌平面（TAP）阻滞已显示出围手术期镇痛的前景，但关于最佳剂量方案的数据有限。
评估左旋布比卡因在小儿超声引导下TAP阻滞成功时的最佳剂量。
采用Dixon上下序贯法的剂量探索前瞻性研究。
大学医院儿科麻醉科。
27例年龄1至5岁计划行日间择期疝修补术的连续患儿。
在标准化全身麻醉诱导后，用固定体积为0.2 ml/kg的左旋布比卡因溶液进行超声引导下TAP阻滞。左旋布比卡因的剂量通过Dixon上下法从0.5 mg/kg开始确定，间隔为0.1 mg/kg。阻滞失败定义为心率或平均动脉压较基线升高20%。补救性镇痛包括手术期间静脉输注瑞芬太尼和在麻醉后护理单元（PACU）静脉注射纳布啡。使用FLACC（面部、腿部、活动、哭闹和安慰度）疼痛量表、PACU和日间病房的补救性镇痛药物消耗量以及家长在家中的术后疼痛测量评分对患者进行评估。
采用Dixon上下序贯法获得的在50%的病例中导致有效TAP阻滞的左旋布比卡因平均有效剂量（ED50）。通过自抽样进一步估计ED50和ED95。
根据上下阶梯法得出的ED50为0.22 mg/kg[95%置信区间（CI）0.19至0.25]。原始数据集的自抽样重复结果得出ED50和ED95估计值分别为0.16 mg/kg（95%CI 0.11至0.24）和0.43 mg/kg（95%CI 0.30至0.57）。
作为多模式镇痛策略的一部分，用0.2%左旋布比卡因0.2 ml/kg进行超声引导下TAP阻滞可为95%接受疝修补术的小儿提供成功的围手术期镇痛。
