Zavras Nick, Tsamoudaki Stella, Christianakis Efstratios, Schizas Demetrios, Pikoulis Emmanuel, Kyritsi Helen, Chrousos George
Department of Surgery, ATTIKO University Hospital, Athens-Greece.
Department of Pediatric Surgery, Penteli, General Children's Hospital, P. Penteli, Athens-Greece.
Saudi J Anaesth. 2014 Jan;8(1):45-50. doi: 10.4103/1658-354X.125936.
circumcision in children is a painful procedure. We aim compare the intraoperative and postoperative efficacy of three different surgical procedures of the ring block using levobupivacaine 0.25% combined with rectal paracetamol as opposed to rectal paracetamol alone.
the study included 106 boys scheduled to undergo circumcision. The patients were randomly assigned within two groups to receive either ring block with levobupivacaine 0.25% and rectal paracetamol 30 mg/kg, or rectal paracetamol 30 mg/kg alone. The following surgical procedures were performed: sutureless proctoplasty, preputial plasty, and conventional circumcision. The efficacy of intraoperative analgesia was estimated on the basis of increases in heart rate and mean arterial pressure. Postoperatively, children were assessed for pain, pain-free (PF) period, and the total doses of analgesics administered during hospitalization, on the day after discharge, and on the first and second postoperative days.
all children remained stable during anesthesia. Postoperatively, the mean pain score did not show statistical differences between the groups. Children who received combined analgesia had a longer PF period (P < 0.001). However, the total doses of paracetamol administered during the observational period showed no differences. Children undergoing sutureless prepuceplasty received lower doses of paracetamol postoperatively (P < 0.001).
subcutaneous ring block either with levobupivacaine 0.25% plus rectal paracetamol or rectal paracetamol alone provides adequate intraoperative and postoperative analgesia in circumcised children. However, combined analgesia allows a longer PF period. The need for less analgesic administration in children undergoing sutureless prepuceplasty could mean that the circumcision techniques might be a mitigating factor in terms of pain.
儿童包皮环切术是一种痛苦的手术。我们旨在比较0.25%左旋布比卡因联合直肠用对乙酰氨基酚与单纯直肠用对乙酰氨基酚在三种不同包皮环切术环形阻滞中的术中及术后效果。
该研究纳入了106名计划接受包皮环切术的男孩。患者被随机分为两组，一组接受0.25%左旋布比卡因环形阻滞加30mg/kg直肠用对乙酰氨基酚，另一组仅接受30mg/kg直肠用对乙酰氨基酚。实施了以下手术：无缝合包皮成形术、包皮整形术和传统包皮环切术。根据心率和平均动脉压的升高来评估术中镇痛效果。术后，对儿童进行疼痛、无痛（PF）期以及住院期间、出院后第一天和术后第一、二天给予的镇痛药总剂量的评估。
所有儿童在麻醉期间均保持稳定。术后，两组间平均疼痛评分无统计学差异。接受联合镇痛的儿童PF期更长（P<0.001）。然而，观察期内对乙酰氨基酚的总给药剂量无差异。接受无缝合包皮成形术的儿童术后对乙酰氨基酚剂量较低（P<0.001）。
0.25%左旋布比卡因加直肠用对乙酰氨基酚或单纯直肠用对乙酰氨基酚的皮下环形阻滞可为接受包皮环切术的儿童提供充分的术中及术后镇痛。然而，联合镇痛可使PF期更长。无缝合包皮成形术儿童所需镇痛药较少可能意味着包皮环切技术在疼痛方面可能是一个缓解因素。
