Feng Jumian, Wang Huaizhen, Peng Liangming, Xu Haiping, Song Xingrong
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
J Cardiothorac Vasc Anesth. 2023 Apr;37(4):539-546. doi: 10.1053/j.jvca.2022.12.006. Epub 2022 Dec 11.
To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would improve postoperative analgesia in infants and small children undergoing open cardiac surgery in the protocol of an ultra-fast track cardiac anesthesia (UFTCA).
A single-center, prospective, randomized, controlled study.
At a tertiary children's medical center.
A total of 180 children undergoing cardiac surgery, aged 1 month to 3 years.
Patients are allocated randomly to TPVB and parent- and/or nurse-controlled intravenous analgesia (PNCA) group (Group T) or PNCA group (Group P).
The primary outcome is the postoperative pain scores. The secondary outcome are intraoperative consumption of sufentanil, time to extubation, using of neostigmine, cumulative total and invalid PCA attempts in 24 and 48 hours after surgery, hospitalization characteristics, perioperative blood glucose, postoperative arterial oxygen partial pressure, arterial carbon dioxide partial pressure (PaCO) and brain natriuretic peptide (BNP). The postoperative pain scores within 24 hours, intraoperative consumption of sufentanil, total, and invalid PCA attempts in 24 and 48 hours, perioperative blood glucose and BNP on the seventh day in Group T were all significantly lower than those in Group P (p < 0.001). The time to extubation, the use of neostigmine, and PaCO on the sixth hour, postoperatively, were significantly smaller in Group T than those in Group P (p < 0.05). There were no significant differences in the hospitalizations between the 2 groups.
A combination of bilateral single dose TPVB and PNCA pain management is superior to a PNCA pain management alone in infants and small children undergoing open cardiac surgery and contributes to a rapid recovery with preferable perioperative outcomes in the protocol of UFTCA.
评估在超快通道心脏麻醉（UFTCA）方案中，术前双侧胸椎旁神经阻滞（TPVB）是否能改善接受心脏直视手术的婴幼儿的术后镇痛效果。
单中心、前瞻性、随机对照研究。
一家三级儿童医疗中心。
总共180名接受心脏手术的儿童，年龄在1个月至3岁之间。
患者被随机分配至TPVB与家长和/或护士控制静脉镇痛（PNCA）组（T组）或PNCA组（P组）。
主要结局是术后疼痛评分。次要结局包括术中舒芬太尼用量、拔管时间、新斯的明使用情况、术后24小时和48小时内PCA累计总次数及无效次数、住院特征、围手术期血糖、术后动脉血氧分压、动脉血二氧化碳分压（PaCO）和脑钠肽（BNP）。T组术后24小时内的疼痛评分、术中舒芬太尼用量、术后24小时和48小时内PCA总次数及无效次数、围手术期血糖及术后第7天的BNP均显著低于P组（p < 0.001）。T组术后拔管时间、新斯的明使用情况及术后第6小时的PaCO均显著低于P组（p < 0.05）。两组在住院情况方面无显著差异。
在接受心脏直视手术的婴幼儿中，双侧单次剂量TPVB与PNCA联合疼痛管理优于单纯PNCA疼痛管理，且有助于在UFTCA方案中实现快速康复并获得更好的围手术期结局。
