Landmann Alessandra, Visoiu Mihaela, Malek Marcus M
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Department of Pediatric Anesthesiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
J Pediatr Surg. 2017 Jun;52(6):966-969. doi: 10.1016/j.jpedsurg.2017.03.020. Epub 2017 Mar 16.
Bilateral rectus sheath blocks have proven to be superior to local anesthetic infiltration for umbilical incisions and have been gaining popularity for the treatment of perioperative pain in children. We aim to develop a technique of surgeon performed rectus sheath blocks under laparoscopic-guidance alone.
In phase I, we observed the laparoscopic appearance of a rectus sheath block. The pain management team performed an ultrasound-guided rectus sheath nerve block as we visualized the posterior rectus sheath with the laparoscope. In phase II, after completion of the laparoscopic procedure, we performed a rectus sheath nerve block. Ultrasound was used to identify where the local anesthetic had been injected.
Nineteen patients were included in this study, accounting for 38 rectus sheath blocks. In phase I, we observed with the laparoscope the delivery of ten ultrasound-guided rectus sheath blocks. In phase II, 28 laparoscopic-guided rectus sheath blocks were completed with immediate ultrasound confirmation of correct placement.
We have demonstrated that the rectus sheath nerve block can be performed reliably under laparoscopic-guidance alone. The efficacy of the laparoscopic-guided nerve block compared to the ultrasound-guided approach will need further study in a prospective, randomized trial.
Retrospective review.
对于脐部切口，双侧腹直肌鞘阻滞已被证明优于局部麻醉药浸润，并且在治疗儿童围手术期疼痛方面越来越受欢迎。我们旨在开发一种仅在腹腔镜引导下由外科医生进行腹直肌鞘阻滞的技术。
在第一阶段，我们观察了腹直肌鞘阻滞的腹腔镜表现。当我们用腹腔镜观察腹直肌后鞘时，疼痛管理团队进行了超声引导下的腹直肌鞘神经阻滞。在第二阶段，腹腔镜手术完成后，我们进行了腹直肌鞘神经阻滞。使用超声来确定局部麻醉药的注射位置。
本研究纳入了19例患者，共进行了38次腹直肌鞘阻滞。在第一阶段，我们用腹腔镜观察了10次超声引导下的腹直肌鞘阻滞操作。在第二阶段，完成了28次腹腔镜引导下的腹直肌鞘阻滞，并通过超声立即确认了正确的注射位置。
我们已经证明，仅在腹腔镜引导下即可可靠地进行腹直肌鞘神经阻滞。与超声引导方法相比，腹腔镜引导神经阻滞的疗效需要在前瞻性随机试验中进一步研究。
回顾性研究。
3级。
