Liu Wei, Liu Jianxia, Tan Xingqin, Wang Shouyong
Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Paediatr Anaesth. 2018 Feb;28(2):134-141. doi: 10.1111/pan.13296. Epub 2017 Dec 5.
Trigger thumb is a common hand disability in children and is primarily treated with open surgery. A conscious median nerve block can usually meet the requirements for trigger thumb-releasing surgery in adults; however, its effectiveness in children requires further clarification. The present study aims to demonstrate whether ultrasound-guided lower forearm median nerve blockade is a viable option for children undergoing open surgery for trigger thumb.
A prospective randomized study was designed to compare median nerve blocks guided by ultrasonography with those guided by anatomic landmarks. Following induction of general anesthesia, the children received a median nerve block performed either by ultrasound-guided block of the lower forearm (group U) or landmark-based blocking at the proximal wrist crease level (group T) with a 0.2% ropivacaine injection. The success rates were compared between groups as the primary endpoint; additional sufentanil and propofol administration, anesthesia recovery time, and other secondary endpoints were also compared.
A total of 100 children (age 1-3 years) with ASA status I who were scheduled for open surgery for trigger thumb were included in this study (n = 50 per group). Thirty-seven children in group T and 50 children in group U underwent successful blocks. The rate of unsuccessful blockade was significantly lower in group U than group T (0% and 26%, respectively), and rate of additional sufentanil and propofol administration was also lower in group U than in group T.
Ultrasound-guided lower forearm median nerve block can provide more effective analgesia, a higher success rate, and lower general and local anesthetic dosages than the anatomic landmark-based blocking method in children undergoing open surgery for trigger thumb.
扳机指是儿童常见的手部残疾，主要通过开放手术治疗。清醒状态下的正中神经阻滞通常能满足成人扳机指松解手术的要求；然而，其在儿童中的有效性尚需进一步明确。本研究旨在证明超声引导下的前臂正中神经阻滞对于接受扳机指开放手术的儿童是否是一种可行的选择。
设计一项前瞻性随机研究，比较超声引导下的正中神经阻滞与解剖标志引导下的阻滞。全身麻醉诱导后，儿童接受由0.2%罗哌卡因注射进行的正中神经阻滞，其中一组通过超声引导下的前臂阻滞（U组），另一组通过基于解剖标志在腕横纹近端水平进行阻滞（T组）。比较两组的成功率作为主要终点；还比较了额外舒芬太尼和丙泊酚的使用情况、麻醉恢复时间及其他次要终点。
本研究共纳入100例计划接受扳机指开放手术的ASA I级1至3岁儿童（每组50例）。T组37例儿童和U组50例儿童阻滞成功。U组阻滞失败率显著低于T组（分别为0%和26%），U组额外舒芬太尼和丙泊酚的使用率也低于T组。
对于接受扳机指开放手术的儿童，超声引导下的前臂正中神经阻滞比基于解剖标志的阻滞方法能提供更有效的镇痛、更高的成功率以及更低的全身和局部麻醉剂量。
