局部麻醉浸润与超声引导腹壁神经阻滞在小儿日间腹股沟疝修补术中的镇痛效果比较。

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair.

机构信息

Anesthesia Department, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China.

出版信息

J Perianesth Nurs. 2022 Oct;37(5):699-705. doi: 10.1016/j.jopan.2021.12.006. Epub 2022 Jun 23.

DOI:10.1016/j.jopan.2021.12.006

PMID:35752525

Abstract

PURPOSE

Placement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia.

DESIGN

Randomized controlled trial.

METHODS

Children aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery.

FINDINGS

A total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both).

CONCLUSIONS

AWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.

摘要

目的

在腹腔镜手术后，局部麻醉剂的放置（LAI）或腹壁神经阻滞（AWNB）已被证明可以减轻术后疼痛。我们旨在比较丙泊酚-瑞芬太尼全身麻醉下儿童行双通道腹腔镜腹股沟疝手术后 AWNB 和 LAI 的术中瑞芬太尼消耗和术后疼痛。

设计

随机对照试验。

方法

纳入年龄在 1 至 6 岁之间行双通道腹腔镜腹股沟疝修补术的儿童进行分析。这些儿童接受以下三种麻醉方案之一：（1）标准全身麻醉（SGA）；（2）SGA 加预防性 LAI；（3）SGA 加预防性 AWNB；并相应分类。主要结局变量为术中瑞芬太尼平均输注率和术后 FLACC（面部、腿部、活动、哭泣和安抚）疼痛评分。次要结果数据包括人口统计学资料、术中变量（在三个不同时间点记录的血流动力学和双频谱指数评分）和手术时间。

发现

共有 90 名儿童（每组 30 名）纳入分析。各组间一般资料、术中血流动力学变量、双频谱指数评分和手术时间无显著差异。与其他两组相比，SGA 组的组内血流动力学变量变化更不稳定，而各组的 BIS 评分相似。AWNB 组术中瑞芬太尼输注率明显低于 SGA 或 LAI 组（中位数[25 至 75 百分位数]：0.11[0.11 至 0.11]µg/kg/min，0.33[0.33 至 0.33]µg/kg/min；0.17[0.17 至 0.20]µg/kg/min，P <.001 均），且低于 LAI 组与 SGA 组（P <.001）。AWNB 组术后 FLACC 疼痛评分明显低于 SGA 或 LAI 组（均 P <.001）。