Day Kristopher M, Nair Narayanan M, Sargent Larry A
Department of Plastic Surgery, University of Tennessee College of Medicine, Chattanooga, TN.
J Craniofac Surg. 2018 Jul;29(5):e525-e528. doi: 10.1097/SCS.0000000000004591.
Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults. The authors demonstrate the safe use of LB in pediatric patients with improved pain control following palatoplasty.
Retrospective patient series of all single-surgeon palatoplasty patients treated at a tertiary craniofacial center from August 2014 to December 2015 were included. All patients received 1.3% LB intraoperatively as greater palatal nerve and surgical field blocks in 2-flap V-Y pushback palatoplasty. Postoperative oral intake, opioids administered, duration of hospitalization, and FLACC (face, legs, activity, cry, consolability) pain scores were measured.
Twenty-seven patients (16 males and 11 females, average age of 10.8 months, weight 8.8 kg) received 2.9 ± 0.9 mL (2.6 ± 1.9 mg/kg) 1.3% LB. Average FLACC scores were 2.4 ± 2.2/10 in the postanesthesia care unit and 3.8 ± 1.8/10 while inpatients. Oral intake was first tolerated 10.3 ± 11.5 hours postoperatively and tolerated 496.4 ± 354.2 mL orally in the first 24 hours postoperatively. Patients received 8.5 ± 8.4 mg hydrocodone equivalents (0.46 ± 0.45 mg/kg per d hydrocodone equivalents) and were discharged 2.1 ± 1.3 days postoperatively. Opioid-related adverse events included emesis in 7.4% and pruritis in 3.7% of patients.
The LB may be used safely in pediatric patients. Intraoperative injection of LB during palatoplasty can yield low postoperative opioid use and an early and adequate volume of oral intake over an average hospital stay. Further cost-efficacy studies of LB are needed to assess its value in pediatric plastic surgery.
脂质体布比卡因（LB）是一种长效局部麻醉剂，据报道可减轻成人术后疼痛。作者证明了LB在腭裂修复术后儿童患者中的安全使用，且疼痛控制得到改善。
纳入2014年8月至2015年12月在一家三级颅面中心接受单外科医生腭裂修复手术的所有患者的回顾性系列研究。在两瓣V-Y后推腭裂修复术中，所有患者术中接受1.3%的LB作为腭大神经和手术区域阻滞。测量术后口服摄入量、给予的阿片类药物、住院时间和面部、腿部、活动、哭闹、安慰（FLACC）疼痛评分。
27例患者（16例男性和11例女性，平均年龄10.8个月，体重8.8kg）接受了2.9±0.9mL（2.6±1.9mg/kg）的1.3%LB。麻醉后护理单元的平均FLACC评分为2.4±2.2/10，住院期间为3.8±1.8/10。术后首次耐受口服摄入的时间为10.3±11.5小时，术后24小时内口服耐受量为496.4±354.2mL。患者接受了8.5±8.4mg氢可酮当量（0.46±0.45mg/kg per d氢可酮当量），术后2.1±1.3天出院。阿片类药物相关不良事件包括7.4%的患者出现呕吐和3.7%的患者出现瘙痒。
LB可在儿科患者中安全使用。腭裂修复术中术中注射LB可使术后阿片类药物使用量低，且在平均住院期间早期口服摄入量充足且合适。需要对LB进行进一步的成本效益研究，以评估其在小儿整形手术中的价值。
