Choi Hoon, Jung Seung Ho, Hong Jin Myung, Joo Young Ho, Kim Youme, Hong Sang Hyun
Deparment of Anesthesia and Pain Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.
Department of Anesthesia and Pain Medicine, College of Medicine, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
J Clin Med. 2019 May 30;8(6):769. doi: 10.3390/jcm8060769.
Emergence agitation is common after septorhinoplasty, and postoperative pain is the main risk factor for this condition. Infraorbital and infratrochlear nerve block have been reported to facilitate pain management in patients after nasal procedures. The effect of peripheral nerve block on the incidence of emergence agitation has not been evaluated. Sixty-six patients that were scheduled for septorhinoplasty were assigned to receive bilateral infraorbital and infratrochlear nerve block with either 8 mL of 0.5% ropivacaine (Block group) or isotonic saline (Sham Block group). The incidence of emergence agitation was evaluated using the Riker sedation-agitation scale. Analgesic consumption, hemodynamic parameters, postoperative pain scores, adverse events, and patient satisfaction with analgesia were evaluated. The incidence of emergence agitation was lower in the Block group than in the Sham Block group (6 (20.0%) versus 20 (62.5%), = 0.002). The mean intraoperative remifentanil consumption was lower in the Block group than in the Sham Block group (0.074 ± 0.014 μg/kg/min. versus 0.093 ± 0.019 μg/kg/min., respectively, < 0.0001), as was the proportion of patients that needed postoperative tramadol administration and median postoperative pain score at 0-2 h after surgery (9 (30.0%) versus 21 (65.6%), = 0.011; 3.0 (2.0-4.0) versus 4.0 (3.0-4.0), < 0.0001, respectively). Hemodynamic parameters and the incidence of adverse events were similar between the two groups. The median patient satisfaction score with respect to analgesia was higher in the Block group than in the Sham Block group (3.5 (3.0-4.0) versus 3.0 (3.0-4.0), respectively, = 0.034). The preoperative bilateral infraorbital and infratrochlear nerve block decreased the incidence of emergence agitation after septorhinoplasty.
鼻中隔成形术后出现躁动很常见，术后疼痛是导致这种情况的主要危险因素。据报道，眶下神经和滑车下神经阻滞有助于鼻部手术后患者的疼痛管理。外周神经阻滞对躁动发生率的影响尚未得到评估。66例计划行鼻中隔成形术的患者被分配接受双侧眶下神经和滑车下神经阻滞，其中一组注射8毫升0.5%罗哌卡因（阻滞组），另一组注射等渗盐水（假阻滞组）。使用Riker镇静 - 躁动量表评估躁动发生率。评估镇痛药物消耗量、血流动力学参数、术后疼痛评分、不良事件以及患者对镇痛的满意度。阻滞组的躁动发生率低于假阻滞组（6例（20.0%）对20例（62.5%），P = 0.002）。阻滞组术中瑞芬太尼的平均消耗量低于假阻滞组（分别为0.074±0.014μg/kg/分钟对0.093±0.019μg/kg/分钟，P < 0.0001），术后需要使用曲马多的患者比例以及术后0 - 2小时疼痛评分中位数也是如此（9例（30.0%）对21例（65.6%），P = 0.011；3.0（2.0 - 4.0）对4.0（3.0 - 4.0），P < 0.0001）。两组的血流动力学参数和不良事件发生率相似。阻滞组患者对镇痛的满意度中位数高于假阻滞组（分别为3.5（3.0 - 4.0）对3.0（3.0 - 4.0），P = 0.034）。术前双侧眶下神经和滑车下神经阻滞降低了鼻中隔成形术后的躁动发生率。
