Parameswaran Anantanarayanan, Ganeshmurthy Muruganand V, Ashok Yashoda, Ramanathan Manikandhan, Markus Anthony F, Sailer Hermann F
Professor, Department of Oral and Maxillofacial Surgery, Meenakshi Cleft and Craniofacial Centre, Chennai, India.
Former Resident, Department of Oral and Maxillofacial Surgery, Meenakshi Cleft and Craniofacial Centre, Chennai, India.
J Oral Maxillofac Surg. 2018 Sep;76(9):1873-1881. doi: 10.1016/j.joms.2018.03.037. Epub 2018 Mar 30.
Children undergoing cleft palate repair have pain, dysphagia, and wound irritation in the immediate postoperative phase that may compromise surgical outcomes. This trial evaluates the efficacy of the sphenopalatine ganglion block (SPGB) in optimizing intraoperative hemodynamics and postoperative analgesia in children undergoing primary palatoplasty.
The study was designed as a prospective, double-blind, randomized controlled trial comparing the use of SPGB with general anesthesia (GA) (study group) versus the use of only GA (control group). Routine preoperative documentation included type of cleft, patient weight, hemoglobin (Hb%), packed cell volume (PCV), blood pressure, and echocardiogram. Intraoperative monitoring included heart rate, blood pressure, and surgical field assessment. Postoperatively, the pain score, pain-free duration, and need for rescue analgesics were recorded. Postsurgical changes in Hb% and PCV values were assessed. Data analysis of collected variables was performed using SPSS software (version 16; IBM, Armonk, NY). Quantitative data were assessed for normality using the Shapiro-Wilk test and analyzed using the independent-sample t test, and the Fisher exact test was used for comparison of the binary variable (gender). The outcome variables were compared between the study and control groups after adjustment for confounding variables. P < .05 was considered statistically significant.
We randomized 100 patients undergoing primary palatoplasty under GA into the control group (n = 49) and study group (SPGB) (n = 51). Three patients were excluded from the control group because of changes in intraoperative anesthetic protocol. The results showed statistically significant differences in the postsurgical pain-free duration (19.46 minutes vs 87.59 minutes) and mean blood loss (105.5 mL vs 62 mL) in favor of the study group. Surgical field and postoperative reduction of Hb% and PCV were also significantly favorable for the study group.
SPGB is a potent pre-emptive technique offering excellent perioperative analgesia, hemodynamic stability, and a clear surgical field.
腭裂修复术后的儿童在术后即刻会出现疼痛、吞咽困难和伤口刺激，这些可能会影响手术效果。本试验评估蝶腭神经节阻滞（SPGB）在优化初次腭裂修复术儿童术中血流动力学及术后镇痛方面的疗效。
本研究设计为一项前瞻性、双盲、随机对照试验，比较SPGB联合全身麻醉（GA）（研究组）与单纯使用GA（对照组）的效果。常规术前记录包括腭裂类型、患者体重、血红蛋白（Hb%）、红细胞压积（PCV）、血压和超声心动图。术中监测包括心率、血压和手术视野评估。术后记录疼痛评分、无痛持续时间及急救镇痛药的使用需求。评估术后Hb%和PCV值的变化。使用SPSS软件（版本16；IBM，纽约州阿蒙克）对收集的变量进行数据分析。定量数据采用Shapiro-Wilk检验评估正态性，并使用独立样本t检验进行分析，二元变量（性别）比较采用Fisher精确检验。在对混杂变量进行调整后，比较研究组和对照组的结局变量。P < 0.05被认为具有统计学意义。
我们将100例在GA下行初次腭裂修复术的患者随机分为对照组（n = 49）和研究组（SPGB）（n = 51）。对照组有3例患者因术中麻醉方案改变被排除。结果显示，研究组在术后无痛持续时间（19.46分钟对87.59分钟）和平均失血量（105.5 mL对62 mL）方面有统计学显著差异，且研究组在手术视野以及术后Hb%和PCV降低方面也明显更优。
SPGB是一种有效的超前镇痛技术，可提供良好的围手术期镇痛、血流动力学稳定性及清晰的手术视野。
