超声引导下腹横肌平面阻滞（ILIHB）或周围神经阻滞（PWI）在小儿中的应用：一项前瞻性随机比较镇痛质量的初步研究。

Ultrasound-guided ilioinguinal-iliohypogastric block (ILIHB) or perifocal wound infiltration (PWI) in children: a prospective randomized comparison of analgesia quality, a pilot study.

机构信息

Department of Pediatric Anesthesiology, Altona Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.

Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

出版信息

BMC Anesthesiol. 2020 Oct 3;20(1):256. doi: 10.1186/s12871-020-01170-z.

BACKGROUND

Ilioinguinal-iliohypogastric block (ILIHB) is a well-established procedure for postoperative analgesia after open inguinal surgery in children. This procedure is effective and safe, especially when ultrasound is used. Data availability for comparing ultrasound-guided blocks versus wound infiltration is still weak. The study was designed to determine the efficacy of ultrasound-guided ILIHB (US-ILIHB) on postoperative pain control in pediatric patients following a inguinal daycase surgery, compared with perifocal wound infiltration (PWI) by the surgeon.

METHODS

This randomized, double-blinded trail was conducted in pediatric patients aged from 6 months to 4 years. The total number of children included in the study was 103. Patients were allocated at random in two groups by sealed envelopes. The ILIHB group recieved 0,2% ropivacain for US-ILIHB after anesthesia induction. The PWI group recieved 0,2% ropivacain for PWI performed by a surgeon before wound closure. Parameters recorded included the postoperative pain score, pain frequency, time to first analgesics and consumption of analgesics.

RESULTS

US-ILIHB significantly reduced the occurrence of pain within the first 24 h after surgery (7.7%, p = 0.01). Moreover, the pain-free interval until administration of the first dose of opioids was 21 min longer, on average (p = 0.003), following US-ILIHB compared to perifocal wound infiltration. 72% of children who received US-ILIHB did not require additional opioids, as compared to 56% of those who received PWI.

CONCLUSION

Thus our study demonstrates that US-ILIHB ensures better postoperative analgesia in children and should be prioritized over postoperative PWI.

TRAIL REGISTRATION

UIHBOPWIIC, DRKS00020987 . Registered 20 March 2020 - Retrospectivley registered.

背景

髂腹下-髂腹股沟阻滞（ILIHB）是小儿开放性腹股沟手术后一种成熟的术后镇痛方法。该方法有效且安全，尤其是在超声引导下使用时。比较超声引导下阻滞与伤口浸润的研究数据仍然不足。本研究旨在比较超声引导下髂腹股沟阻滞（US-ILIHB）与手术医师行局部伤口浸润（PWI）对小儿日间腹股沟手术后的术后疼痛控制效果。

方法

本研究为前瞻性、随机、双盲临床试验，纳入年龄 6 个月至 4 岁的小儿患者。研究共纳入 103 例患儿，采用密封信封法将其随机分为两组。麻醉诱导后，ILIHB 组接受 0.2%罗哌卡因行 US-ILIHB；PWI 组在伤口缝合前由手术医师接受 0.2%罗哌卡因行 PWI。记录术后疼痛评分、疼痛发生频率、首次使用镇痛药时间和镇痛药使用量。

结果

US-ILIHB 组术后 24 小时内疼痛发生率显著降低（7.7%，p=0.01）。与 PWI 组相比，US-ILIHB 组患儿首次使用阿片类药物前的无疼痛间隔时间平均延长 21 分钟（p=0.003）。US-ILIHB 组 72%的患儿无需额外使用阿片类药物，而 PWI 组则有 56%的患儿需要。