Seyedhejazi Mahin, Moghadam Abdolnaser, Sharabiani Behzad Aliakbari, Golzari Samad E J, Taghizadieh Nasrin
Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Saudi J Anaesth. 2015 Oct-Dec;9(4):348-52. doi: 10.4103/1658-354X.154704.
Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair.
In a randomized clinical trial, 66 neonates and infants (weight <5 kg) undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 μg adrenaline (group C) or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 μg adrenaline (group S). Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation.
Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05). The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03). Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001). Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04).
More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair.
腹股沟疝是早产儿的常见疾病，需要进行手术修复。尽管早产儿术后发生呼吸暂停的风险增加，但该手术传统上是在全身麻醉下进行的。最近，包括脊髓阻滞和骶管阻滞在内的区域麻醉方法已被提议作为这组患者安全有效的替代麻醉方法。本研究评估了接受腹股沟疝修补术的早产儿的清醒骶管阻滞和脊髓阻滞。
在一项随机临床试验中，大不里士儿童教学医院在12个月期间招募了66例接受腹股沟疝修补术的新生儿和婴儿（体重<5kg）。他们被随机分为两组，分别接受1ml/kg的0.25%布比卡因加20μg肾上腺素的骶管阻滞（C组）或1mg/kg的0.5%布比卡因加20μg肾上腺素的脊髓阻滞（S组）。记录手术期间及术后直至24小时的生命体征和疼痛评分。
在整个研究期间，C组心率和收缩压的下降明显更高（P<0.05）。S组的平均恢复时间明显更长（27.3±5.5分钟对21.8±9.3分钟；P=0.03）。S组术后镇痛需求明显更频繁（75.8%对36.4%；P=0.001）。S组麻醉失败率明显更高（24.4%对6.1%；P=0.04）。
在接受腹股沟疝修补术的清醒早产儿中，与脊髓麻醉相比，骶管阻滞成功率更高、恢复时间更短且术后镇痛需求更低，这可能使其成为一种更优的麻醉技术。
