Sahin Levent, Soydinc Mahmut H, Sen Elzem, Cavus Omer, Sahin Mehrican
Department of Anesthesiology, Gaziantep University, Gaziantep, Turkey. E-mail.
Saudi Med J. 2017 Sep;38(9):952-959. doi: 10.15537/smj.2017.9.20505.
To compare the analgesic efficiencies of caudal blocks, ultrasound (US)-guided transversus abdominis plane (TAP) blocks, and ilio-inguinal/ilio-hypogastric (II/IH) blocks performed to provide postoperative analgesia in pediatric patients undergoing unilateral lower abdominal surgery. Methods: This prospective, randomized, single-blinded study was conducted in the Department of Pediatric Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey from July 2013 to January 2015. The doses used were as follows: 0.5 ml/kg (group T), 0.3 ml/kg (group I), and 0.7 ml/kg (group C) of a 0.25% levobupivacaine solution with 1/200,000 adrenalin for the TAP block, II/IH block, and caudal block. The primary aim was to compare postoperative analgesic consumption within the first 24 hours after surgery. The secondary aim were to compare the mCHEOPS score, first analgesic requirement time, vital signs, and undesirable effects such as nausea and vomiting, which were recorded in the surgical ward at 1, 4, 8, 16, and 24 hours after surgery. Results: Ninety patients with American Society of Anesthesiology physical status class I-II were randomized into 3 groups (group I, group T, and group C). The total amount of analgesic consumption was significantly higher in Group I compared with Groups T and C (p=0.003). Pain scores at 1, 4, and 8 hours were significantly higher in Group I compared with the other 2 groups; however, pain scores in Group I at 16 hours were significantly higher only compared with Group C (p less than 0.05). Conclusion: Caudal and TAP blocks are more effective than II/IH nerve blocks in the early postoperative period.
比较骶管阻滞、超声（US）引导下腹横肌平面（TAP）阻滞和髂腹股沟/髂腹下神经（II/IH）阻滞在接受单侧下腹部手术的儿科患者中提供术后镇痛的镇痛效果。方法：本前瞻性、随机、单盲研究于2013年7月至2015年1月在土耳其加济安泰普大学医学院儿外科进行。所用剂量如下：用于TAP阻滞、II/IH阻滞和骶管阻滞的0.25%左旋布比卡因溶液加1/200,000肾上腺素，分别为0.5 ml/kg（T组）、0.3 ml/kg（I组）和0.7 ml/kg（C组）。主要目的是比较术后24小时内的术后镇痛药物消耗量。次要目的是比较术后1、4、8、16和24小时在外科病房记录的改良小儿疼痛观察评分（mCHEOPS）、首次镇痛需求时间、生命体征以及恶心和呕吐等不良反应。结果：90例美国麻醉医师协会身体状况分级为I-II级的患者被随机分为3组（I组、T组和C组）。I组的镇痛药物总消耗量显著高于T组和C组（p = 0.003）。I组在术后1、4和8小时的疼痛评分显著高于其他两组；然而，I组在术后16小时的疼痛评分仅与C组相比显著更高（p < 0.05）。结论：在术后早期，骶管阻滞和TAP阻滞比II/IH神经阻滞更有效。
