Bakhet Wahba Z, Wahba Hassan A, El Fiky Lobna M, Debis Hossam
Department of Anesthesia, Ain Shams University, Cairo, Egypt.
Department of Otolaryngology, Ain Shams University, Cairo, Egypt.
J Anaesthesiol Clin Pharmacol. 2020 Jul-Sep;36(3):366-370. doi: 10.4103/joacp.JOACP_18_19. Epub 2020 Sep 26.
Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA.
Prospective, randomized, double-blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, = 35) or control (CT group, = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well.
The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2-12] vs. 3 [0-8] h, < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) μg/kg/min; = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups.
Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.
使用瑞芬太尼的全静脉麻醉可提供良好的手术条件，且不影响术中镫骨肌反射阈值（ESRT）。然而，瑞芬太尼会导致痛觉过敏并增加术后阿片类药物的需求量。局部麻醉药浸润是替代阿片类药物提供镇痛的方法。然而，耳科医生避免使用它，因为它会消除ESRT。我们研究了在全静脉麻醉下进行的小儿人工耳蜗植入手术中，预防性局部麻醉药浸润对术中ESRT和阿片类药物需求量的影响。
前瞻性、随机、双盲、对照研究，纳入70例在全静脉麻醉下接受人工耳蜗植入的儿童，随机分为局部麻醉组（LA组，n = 35）或对照组（CT组，n = 35）。主要结局是术后24小时内曲马多的总消耗量，次要结局是首次要求镇痛的时间、术后疼痛评分、ESRT以及丙泊酚和瑞芬太尼的需求量。术后呕吐的发生率也进行了记录。
LA组术后24小时内曲马多的总消耗量显著低于CT组（8.25 [4.3] 对比16.5 [6.57] mg，P < 0.01）。与CT组相比，LA组首次要求镇痛的时间显著延长[8 [2 - 12] 对比3 [0 - 8] 小时，P < 0.01]。术后15分钟、30分钟、2小时、4小时和6小时时，LA组的面部、腿部、活动、哭闹安抚疼痛评分显著更低。CT组的平均瑞芬太尼输注速率[均值（标准差）]显著高于LA组[0.7 (0.3) 对比0.5 (0.2) μg/kg/分钟；P = 0.001]。两组之间的ESRT反应、丙泊酚需求量和术后呕吐发生率无显著差异。
在全静脉麻醉下进行的小儿人工耳蜗植入手术中，预防性局部麻醉药浸润可减少阿片类药物的需求量，且不会减弱ESRT。
