Akıncı Gülşah, Hatipoğlu Zehra, Güleç Ersel, Özcengiz Dilek
Clinic of Anaesthesiology and Reanimation, 25 December State Hospital, Gaziantep, Turkey.
Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey.
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):295-300. doi: 10.5152/TJAR.2019.81205. Epub 2019 Feb 21.
To compare the effects of ultrasound-guided thoracic paravertebral block (PVB) and intravenous paracetamol on postoperative pain control in paediatric patients undergoing percutaneous nephrolithotomy (PNL).
Forty patients aged 1-5 years, with an American Society of Anesthesiologists physical status I-II, scheduled for PNL were enrolled into this prospective randomised controlled trial. After arrival in the operating room, all patients were administered standardised general anaesthesia. Patients in Group PVB received ultrasound-guided PVB using bupivacaine 0.5% at a total volume of 0.5 mL kg at the vertebral levels T11, T12 and L1. Patients in Group P were administered paracetamol intravenously (15 mg kg) before the beginning of surgery. Patients in both groups were given tramadol (1 mg kg) for supplemental analgesia. Patient demographics, haemodynamic parameters, peripheral oxygen saturation and sevoflurane concentration were recorded. The Face, Legs, Activity, Cry and Consolability pain scores; satisfaction of parents; the number of patients requiring supplemental analgesia; and complications were evaluated during the postoperative period.
Pain scores were significantly lower in Group PVB compared with Group P (p=0.001). There were no analgesic requirements in Group PVB; however, all patients needed a supplemental analgesic in Group P. Parental satisfaction was higher in Group PVB than in Group P.
This study demonstrated that ultrasound-guided PVB provides more effective postoperative analgesia with no side effects compared to intravenous paracetamol in children undergoing PNL.
比较超声引导下胸椎旁神经阻滞（PVB）与静脉注射对乙酰氨基酚在接受经皮肾镜取石术（PNL）的儿科患者术后疼痛控制中的效果。
40例年龄在1至5岁、美国麻醉医师协会身体状况分级为I-II级、计划接受PNL的患者被纳入这项前瞻性随机对照试验。到达手术室后，所有患者均接受标准化全身麻醉。PVB组患者在T11、T12和L1椎体水平接受超声引导下的PVB，使用0.5%布比卡因，总量为0.5 mL/kg。P组患者在手术开始前静脉注射对乙酰氨基酚（15 mg/kg）。两组患者均给予曲马多（1 mg/kg）用于补充镇痛。记录患者人口统计学资料、血流动力学参数、外周血氧饱和度和七氟醚浓度。在术后期间评估面部、腿部、活动、哭闹和安慰性疼痛评分；家长满意度；需要补充镇痛的患者数量；以及并发症情况。
PVB组的疼痛评分显著低于P组（p = 0.001）。PVB组无需镇痛；然而，P组所有患者均需要补充镇痛。PVB组家长的满意度高于P组。
本研究表明，对于接受PNL的儿童，超声引导下的PVB与静脉注射对乙酰氨基酚相比，能提供更有效的术后镇痛且无副作用。
