Zheng Kang, Li Bin, Sun Jie
Department of Anesthesiology,Nanjing Pukou District Hospital of Chinese Medicine, Nanjing, China.
Department of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, China.
Heliyon. 2023 Feb 10;9(3):e13631. doi: 10.1016/j.heliyon.2023.e13631. eCollection 2023 Mar.
ː Pain management is essential in postoperative settings, especially with pediatric patients. Donor site pain after rib cartilage harvest is severe, particularly during the early postoperative period. This study aimed to explore the effectiveness of ultrasound guided single-injection intercostal nerve block (ICNB) as a component of multimodal analgesia for pediatrics undergoing autologous auricular reconstruction.
ː Fifty pediatric patients aged 6-16 years and scheduled for 2 rib cartilages harvest surgery were enrolled in this double-blind, prospective and randomized study. Pediatrics were randomly assigned into two groups: the intercostal nerve block group (group B) and the control group (group C). The nerve block was performed with 2 ml 0.25% ropivacaine each intercostal nerve in group B. Patients from group C received Tramadol 2 mg/kg by the end of the surgery as control. Tramadol-based patient-controlled intravenous analgesia and rescue analgesia were given in both groups. The primary outcome was pain scores at early postoperative period (VAS and FLACC scale, 4 h, and 8 h). The secondary outcome was the postoperative Tramadol consumption and time point of first rescue analgesic demand.
ː VAS score was significantly lower in group B than group C at 4 h and 8 h postoperatively [2.5(2-5) vs. 4(2.5-5.5), = 0.041 at 4 h; 3(2.5-4.5) vs. 4(3-5), = 0.047 at 8 h]. Total Tramadol consumption in group B decreased significantly in contrast with group C at 8 h ( < 0.01), 12 h, 24 h and 48 h ( < 0.05, respectively). The first rescue analgesia demand and number of rescue Tramadol in block group was considerably delayed or reduced than control group ( < 0.01, < 0.05, respectively).
ː Our findings indicated that ultrasound guided ICNB slightly but significantly reduced pain scores, and Tramadol consumption in pediatric patients after rib cartilage harvest as compared to who didn't receive nerve block at 4 h and 8 h postoperatively. Unified ICNB ropivacaine dosage might detrimental to providing superior analgesia.
疼痛管理在术后环境中至关重要，尤其是对于儿科患者。肋软骨采集后的供区疼痛较为严重，特别是在术后早期。本研究旨在探讨超声引导下单次注射肋间神经阻滞（ICNB）作为多模式镇痛的一部分，对接受自体耳廓重建的儿科患者的有效性。
本双盲、前瞻性、随机研究纳入了50例年龄在6至16岁、计划进行2次肋软骨采集手术的儿科患者。将患儿随机分为两组：肋间神经阻滞组（B组）和对照组（C组）。B组每根肋间神经注射2ml 0.25%罗哌卡因进行神经阻滞。C组患者在手术结束时接受2mg/kg曲马多作为对照。两组均给予基于曲马多的患者自控静脉镇痛和补救镇痛。主要结局指标为术后早期（4小时和8小时）的疼痛评分（视觉模拟评分法和面部表情疼痛评分量表）。次要结局指标为术后曲马多消耗量及首次补救镇痛需求的时间点。
术后4小时和8小时，B组的视觉模拟评分法评分显著低于C组[4小时时为2.5（2 - 5）对4（2.5 - 5.5），P = 0.041；8小时时为3（2.5 - 4.5）对4（3 - 5），P = 0.047]。与C组相比，B组在8小时（P < 0.01）、12小时、24小时和48小时（分别为P < 0.05）的曲马多总消耗量显著降低。阻滞组首次补救镇痛需求及补救曲马多数量均比对照组显著延迟或减少（分别为P < 0.01，P < 0.05）。
我们的研究结果表明，与未接受神经阻滞的患儿相比，超声引导下的肋间神经阻滞在术后4小时和8小时能轻微但显著降低儿科患者肋软骨采集后的疼痛评分及曲马多消耗量。统一的罗哌卡因肋间神经阻滞剂量可能不利于提供更好的镇痛效果。
