Elnabtity Ali Mohamed, Ibrahim Mohamed
Lecturer of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Associate Professor of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Saudi J Anaesth. 2018 Jul-Sep;12(3):399-405. doi: 10.4103/sja.SJA_760_17.
Intraperitoneal local anesthetic is an effective analgesic approach in laparoscopic appendectomy in adults. The aim of the study was to compare the postoperative pain when intraperitoneal bupivacaine is administered alone versus the addition of dexmedetomidine to it in children undergoing a laparoscopic appendectomy.
In this prospective randomized trial, 52 children were randomly allocated to Group B who received intraperitoneal bupivacaine 0.25% (2 mg/kg) or Group BD who received intraperitoneal bupivacaine 0.25% (2 mg/kg) plus dexmedetomidine (1 mcg/kg) for postoperative analgesia in children undergoing laparoscopic appendectomy. Postoperative pethidine consumption at day 1 was recorded and considered the primary outcome of the study. Patients were evaluated for pain scores at 0, 2, 4, 6, 12, and 24 h, time to first request of pethidine, sedation scores at 0, 2, 4, and 6 h, length of hospital stay, and parents' satisfaction. Chi-square, Fisher's exact, Student's -test, and Mann-Whitney U-tests were used for analysis.
Postoperative visual analog scale scores were lower in Group BD at 2, 4, and 6 h (mean = 3, 3, 3, respectively) compared with Group B (mean = 4, 5, 4, respectively) ( < 0.05). Patients in Group BD had more sedation scores at 0, 2, and 4 h ( < 0.05), longer time to first rescue analgesia ( = 0.03), lesser rescue analgesic consumption ( = 0.02), shorter length of hospital stay ( = 0.02), and higher parents' satisfaction ( = 0.01).
Adding dexmedetomidine to intraperitoneal bupivacaine provides adequate postoperative analgesia in children undergoing laparoscopic appendectomy.
腹腔内局部麻醉是成人腹腔镜阑尾切除术中一种有效的镇痛方法。本研究的目的是比较在接受腹腔镜阑尾切除术的儿童中，单独使用腹腔内布比卡因与在其中添加右美托咪定后的术后疼痛情况。
在这项前瞻性随机试验中，52名儿童被随机分配至B组，接受0.25%（2mg/kg）腹腔内布比卡因，或BD组，接受0.25%（2mg/kg）腹腔内布比卡因加右美托咪定（1mcg/kg），用于接受腹腔镜阑尾切除术儿童的术后镇痛。记录第1天的术后哌替啶消耗量，并将其视为研究的主要结局。在0、2、4、6、12和24小时评估患者的疼痛评分、首次要求使用哌替啶的时间、在0、2、4和6小时的镇静评分、住院时间以及家长满意度。采用卡方检验、Fisher精确检验、学生t检验和Mann-Whitney U检验进行分析。
与B组（平均分别为4、5、4）相比，BD组在2、4和6小时的术后视觉模拟量表评分更低（平均分别为3、3、3）（P<0.05）。BD组患者在0、2和4小时的镇静评分更高（P<0.05），首次补救镇痛的时间更长（P=0.03），补救镇痛药物消耗量更少（P=0.02），住院时间更短（P=0.02），家长满意度更高（P=0.01）。
在腹腔内布比卡因中添加右美托咪定可为接受腹腔镜阑尾切除术的儿童提供充分的术后镇痛。
