Dadure Christophe, Veyckemans Francis, Bringuier Sophie, Habre Walid
Department of Paediatric and Gynaecology Anaesthesia, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.
Functional Genomics Institute, U1191 INSERM Unit, Montpellier, France.
Paediatr Anaesth. 2019 Nov;29(11):1128-1135. doi: 10.1111/pan.13741. Epub 2019 Sep 11.
Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT.
Data on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2-week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed.
Regional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported.
These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.
最近，欧洲前瞻性观察性多中心队列研究APRICOT报告了31000多例儿科手术的麻醉技术和并发症。本研究的主要目的是分析参与APRICOT的33个国家区域麻醉的当前实践情况。
区域麻醉技术的数据从APRICOT数据库（33个欧洲国家的261个中心）中提取。所有出生至16岁的儿童在为期2周的时间内均符合纳入标准。分析了区域麻醉的类型（无论是否在清醒状态下使用，或是否联合镇静或全身麻醉）、引导技术以及所使用的药物。
4377例儿科外科手术使用了区域麻醉。绝大多数手术在全身麻醉下进行，采用中枢阻滞和躯干阻滞，分别占所实施技术的42.6%和41.8%。骶管阻滞占所有中枢阻滞的76.9%。阴茎阻滞和髂腹股沟/髂腹下神经阻滞是最常实施的躯干阻滞。麻醉医生主要使用解剖标志；仅23.8%的病例应用了超声引导。在参与研究的欧洲国家中，区域麻醉技术和局部麻醉药的使用存在很大差异。未报告严重并发症。
这些数据表明，在APRICOT研究中，中枢阻滞和躯干阻滞占主导地位。超声引导主要用于外周神经阻滞，而中枢阻滞采用标志技术进行。
