包皮环切术预防性镇痛技术的比较：阴茎背神经阻滞、骶管阻滞还是皮下注射吗啡？

Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or subcutaneous morphine?

作者信息

Canakci Ebru, Yagan Ozgur, Tas Nilay, Mutlu Tugce, Cirakoglu Abdullah, Benli Erdal

机构信息

Department of Anaesthesiology and Reanimation, Ordu University School of Medicine, Turkey.

Ordu University Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Turkey.

出版信息

J Pak Med Assoc. 2017 Feb;67(2):159-165.

PMID:28138164

Abstract

OBJECTIVE

To compare 3 different techniques of preventive analgesia before circumcision operations in male children between 6-12 years of age. Our objective was to investigate the duration and quality of postoperative analgesia in patients, who were subject to caudal block technique, dorsal penile nerve block or who were administered subcutaneous morphine.

METHODS

The prospective, randomised, single-blind study was conducted at Ordu University Training and Research Hospital, Ordu, Turkey, from January 1 to June 30, 2015, and comprised boys aged 6-12 years, who were scheduled to undergo circumcision operation. All patients were under general anaesthesia by means of laryngeal masks. The patients were randomised into 3 equal groups. The patients in Group C received caudal block with bupivacaine 0.25% in a total volume of 0.50 ml/kg in lateral position. Those in Group M received injections of 100 mcg/kg of subcutaneous morphine into the deltoid muscle. Patients in Group DP were subjected to dorsal penile nerve block with 1 mg/kg of bupivacaine 0.25%. Intraoperative haemodynamic data, pain and sedation scores, according to Children's Hospital of Eastern Ontorio Pain Scale and Ramsay Sedation Scale, were recorded at postoperative 1st, 6th and 24th hours in all cases.

RESULTS

The 60 subjects in the study were divided into 3 groups of 20(33.3%) each. The overall mean age was 7.75±8.12 years. At 1 hour after surgery; 8(40%) cases in Group M, 5(25%) cases in Group DP, and all the 20(100%) cases in Group C had a pain score <6 (p<0.05). When the scores were analysed 12 hours post-operatively, 5(25%) cases in Group M and 10(50%) cases in Group DP had a pain score >6, while the pain scores of all the 20(100%) cases in Group C were <6 (p<0.01). Among the groups, there was no statistically significant difference regarding the sedation scores (p>0.05).

CONCLUSIONS

Using the three methods, analgesia lasted until 12 hours postoperatively, being more evident in the caudal block group, minimising postoperative stress in children and parents.

摘要

目的

比较6至12岁男童包皮环切手术前3种不同的预防性镇痛技术。我们的目的是研究接受骶管阻滞技术、阴茎背神经阻滞或皮下注射吗啡的患者术后镇痛的持续时间和质量。

方法

这项前瞻性、随机、单盲研究于2015年1月1日至6月30日在土耳其奥尔杜市奥尔杜大学培训与研究医院进行，纳入计划接受包皮环切手术的6至12岁男孩。所有患者均通过喉罩进行全身麻醉。患者被随机分为3组，每组人数相等。C组患者在侧卧位接受0.25%布比卡因骶管阻滞，总量为0.50 ml/kg。M组患者在三角肌注射100 mcg/kg皮下吗啡。DP组患者接受1 mg/kg 0.25%布比卡因阴茎背神经阻滞。所有病例均在术后第1、6和24小时记录根据东安大略儿童医院疼痛量表和拉姆齐镇静量表得出的术中血流动力学数据、疼痛和镇静评分。

结果

研究中的60名受试者分为3组，每组20名（33.3%）。总体平均年龄为7.75±8.12岁。术后1小时，M组8例（40%）、DP组5例（25%）、C组所有20例（100%）疼痛评分<6（p<0.05）。术后12小时分析评分时，M组5例（25%）、DP组10例（50%）疼痛评分>6，而C组所有20例（100%）疼痛评分<6（p<～0.01）。各组间镇静评分无统计学显著差异（p>0.05）。