Saleh Amany H, Hassan Passaint F, Elayashy Mohamed, Hamza Hamza M, Abdelhamid Mona H, Madkour Mai A, Tawadros Pierre Z, Omar Heba, Kamel Mohamed M, Zayed Marwa, Helmy Mohamed
Department of Anesthesia , Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
el Haram, Giza, Egypt.
BMC Anesthesiol. 2018 Nov 30;18(1):178. doi: 10.1186/s12871-018-0637-y.
Surgery for aortic coarctation requires special care during anesthesia due to severe pain during the lateral thoracotomy incision, intraoperative hemodynamic instability and the need for large doses of intra- and postoperative analgesics and vasodilators. Additionally, the postoperative care of patients is very important.
We aimed to compare ultrasound-guided paravertebral block performed using bupivacaine alone and bupivacaine with dexamethasone in terms of the intra- and postoperative analgesic requirements and hemodynamics, postoperative complications and ICU stay.
This was a prospective, randomized, controlled, double-blinded study.
Fifty patients aged four to 12 months scheduled for aortic coarctation surgery were randomly divided into two equal groups (n = 25). Patients in group D (dexamethasone) received 0.5 mg/kg bupivacaine 0.25% mixed with 0.1 mg/kg dexamethasone diluted with isotonic saline and those in group C (control) received 0.5 mg/kg bupivacaine 0.25% diluted with isotonic saline (total volume 15 ml in each group). Intraoperative fentanyl consumption and hemodynamics (heart rate, arterial blood pressure) at baseline, 1 min after induction, at skin incision, after 30 min, after clamping, after declamping and at the end of the surgery were recorded, along with the objective pain score (OPS) immediately postoperatively and at 4 h, 8 h, 12 h and 24 h postoperatively and the time to the first request for pethidine. The intra- and postoperative vasodilator doses, time to extubation, ICU stay duration and postoperative complications were also recorded.
The postoperative OPS was significantly lower at 12 and 24 h in group D than in group C. The time to the first request for analgesia was significantly longer in group D than in group C (3.9 ± 2.23 vs 8.6 ± 0.69). Additionally, the time to extubation was significantly shorter in group D.
The use of dexamethasone as an adjuvant in ultrasound-guided paravertebral block in paediatric patients undergoing surgery for aortic coarctation increased the duration of postoperative analgesia with a prolonged time to the first request for analgesics It was also associated with a decreased incidence of postoperative complications.
Trial registration number: NCT03074773 . (Prospectively registered). The initial registration date was 9/3/2017.
由于侧胸壁切开术中疼痛剧烈、术中血流动力学不稳定以及术中和术后需要大剂量的镇痛药和血管扩张剂，主动脉缩窄手术的麻醉需要特别护理。此外，患者的术后护理也非常重要。
我们旨在比较单独使用布比卡因和布比卡因联合地塞米松进行超声引导下椎旁阻滞在术中和术后镇痛需求、血流动力学、术后并发症及重症监护病房（ICU）住院时间方面的差异。
这是一项前瞻性、随机、对照、双盲研究。
将50例年龄在4至12个月计划行主动脉缩窄手术的患者随机分为两组，每组25例。D组（地塞米松组）患者接受0.5mg/kg 0.25%布比卡因与0.1mg/kg地塞米松混合并用等渗盐水稀释后的溶液，C组（对照组）患者接受0.5mg/kg 0.25%布比卡因用等渗盐水稀释后的溶液（每组总体积15ml）。记录术中芬太尼用量以及基线、诱导后1分钟、皮肤切开时、30分钟后、夹闭后、松开夹闭后及手术结束时的血流动力学指标（心率、动脉血压），以及术后即刻、术后4小时、8小时、12小时和24小时的客观疼痛评分（OPS）和首次请求使用哌替啶的时间。还记录术中和术后血管扩张剂的用量、拔管时间、ICU住院时间及术后并发症。
D组术后12小时和24小时的OPS显著低于C组。D组首次请求镇痛的时间显著长于C组（3.9±2.23对8.6±0.69）。此外，D组的拔管时间显著缩短。
在接受主动脉缩窄手术的儿科患者中，地塞米松作为超声引导下椎旁阻滞的辅助用药，可延长术后镇痛时间，延长首次请求镇痛的时间，还可降低术后并发症的发生率。
试验注册号：NCT03074773。（前瞻性注册）。初始注册日期为2017年9月3日。
