Aksu Can, Akay Mustafa Alper, Şen Mehmet Celal, Gürkan Yavuz
Department of Anesthesiology and Reanimation, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
Department of Pediatric Surgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
Paediatr Anaesth. 2019 Oct;29(10):1046-1052. doi: 10.1111/pan.13727. Epub 2019 Sep 2.
Hypospadias is a common congenital malformation in pediatric patients. Surgical repair of this malformation is a painful procedure and has long-term effects. Pudendal and penile nerve blocks are commonly preferred techniques for maintaining postoperative analgesia. However, the conventional landmark-based penile block technique involves numerous potential complications and provides a shorter analgesic period compared to the pudendal block. A promising ultrasound-guided dorsal penile nerve block was recently described. We aimed to compare the analgesic effectiveness of ultrasound-guided penile nerve block with that of neurostimulator-guided pudendal nerve block.
Thirty-three patients aged 1-7 years were included in this prospective, double-blinded, randomized controlled trial. Patients were divided into two groups and received either ultrasound-guided dorsal penile nerve block or neurostimulator-guided pudendal nerve block. All blocks were performed by the same two anesthesiologists, and the same surgeons performed the surgical procedures. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale was used for postoperative pain management. The primary outcome of the study was time to first analgesic requirement. Secondary outcomes were FLACC scores at different time points, and types and cumulative doses of analgesic drugs.
Dorsal penile nerve block provided longer analgesia than pudendal nerve block (32.29 ± 5.47 hours and 21.13 ± 3.53 hours, respectively; differences in mean: 11.16, 95% CI: 7.873-14.465) (P < .001). FLACC scores at the time of first analgesic requirement were significantly lower in dorsal penile nerve block group than pudendal nerve block group (median [IQR]: 2 [2-2.5] and 3 [3-5], respectively; differences in median: -1, 95% CI: -1.851 to -0.149) (P < .001).
Ultrasound-guided dorsal penile nerve block provided a longer analgesic period and reduced opioid consumption compared to neurostimulator-guided pudendal nerve block.
尿道下裂是儿科患者常见的先天性畸形。该畸形的手术修复是一种痛苦的手术，且具有长期影响。阴部神经阻滞和阴茎神经阻滞是维持术后镇痛常用的首选技术。然而，传统的基于体表标志的阴茎阻滞技术存在许多潜在并发症，与阴部神经阻滞相比，镇痛时间较短。最近描述了一种有前景的超声引导下阴茎背神经阻滞。我们旨在比较超声引导下阴茎神经阻滞与神经刺激器引导下阴部神经阻滞的镇痛效果。
33例年龄在1至7岁的患者纳入了这项前瞻性、双盲、随机对照试验。患者分为两组，分别接受超声引导下阴茎背神经阻滞或神经刺激器引导下阴部神经阻滞。所有阻滞均由同两位麻醉医生进行，相同的外科医生实施手术。采用面部、腿部、活动、哭闹及安慰（FLACC）量表进行术后疼痛管理。该研究的主要结局指标是首次需要镇痛的时间。次要结局指标是不同时间点的FLACC评分、镇痛药物的类型和累积剂量。
阴茎背神经阻滞的镇痛时间比阴部神经阻滞更长（分别为32.29±5.47小时和21.13±3.53小时；平均差异：11.16，95%可信区间：7.873 - 14.465）（P <.001）。首次需要镇痛时，阴茎背神经阻滞组的FLACC评分显著低于阴部神经阻滞组（中位数[四分位间距]：分别为2[2 - 2.5]和3[3 - 5]；中位数差异：-1，95%可信区间：-1.851至-0.149）（P <.001）。
与神经刺激器引导下阴部神经阻滞相比，超声引导下阴茎背神经阻滞的镇痛时间更长，且减少了阿片类药物的用量。
