Rajan Sunil, Sasikumar Niranjan Kumar, Rudrahitlu Varsha, Mathew Jacob, Barua Kaushik, Kumar Lakshmi
Department of Anesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
J Anaesthesiol Clin Pharmacol. 2023 Apr-Jun;39(2):220-225. doi: 10.4103/joacp.joacp_279_21. Epub 2023 Feb 3.
Sphenopalatine ganglion block (SPGB) given as injection provides excellent perioperative analgesia during palatoplasty. Our objectives were to assess the effect of transmucosal SPGB on anesthetic requirements, intraoperative hemodynamics, recovery time, and emergence delirium in children undergoing palatoplasty.
This prospective, randomized study was conducted in 30 children with cleft palate undergoing palatoplasty, divided into two equal groups. After induction and intubation, patients in Group B received bilateral SPGB using cotton-tipped applicators soaked in 2% lignocaine, which were passed through both the nares, and the distal tip was positioned just superior to middle turbinate and anterior to pterygopalatine fossa and sphenopalatine ganglion. In Group C, saline-soaked cotton applicators were used. All patients received general anesthesia as per a standardized protocol. Intraoperative heart rate, mean arterial pressure, the requirement of anesthetics, extubation time, and emergence delirium were compared.
Compared with Group C, patients in Group B had significantly lower sevoflurane consumption (17.2 ± 2.6 vs. 27.5 ± 5.0mL, < 0.001) and fentanyl consumption (2.2 ± 0.5 vs. 3.2 ± 0.6 μ/kg, < 0.001).The extubation time was significantly shorter in Group B (3.9 ± 0.7 vs. 9.5 ± 1.6 minutes, < 0.001). PAED (Pediatric Anesthesia Emergence Delirium Scale) scores at 5and 10 minutes were significantly higher in Group C < 0.001). Intraoperative heart rate was significantly higher in Group C. Group C had significantly higher mean arterial pressure at 15, 60, and 75 minutes.
Preoperative, SPGB administered by mucosal application of local anesthetic significantly reduced sevoflurane and fentanyl requirements, with stable hemodynamics, quicker recovery, and less emergence delirium in children undergoing palatoplasty.
注射蝶腭神经节阻滞（SPGB）可在腭裂修复术中提供出色的围手术期镇痛效果。我们的目标是评估经黏膜SPGB对腭裂修复术患儿麻醉需求、术中血流动力学、恢复时间及苏醒期谵妄的影响。
本前瞻性随机研究纳入30例接受腭裂修复术的患儿，分为两组，每组15例。诱导插管后，B组患儿使用浸有2%利多卡因的棉棒经双侧鼻孔进行双侧SPGB，棉棒远端置于中鼻甲上方、翼腭窝和蝶腭神经节前方。C组使用浸有生理盐水的棉棒。所有患者均按照标准化方案接受全身麻醉。比较术中心率、平均动脉压、麻醉药物需求量、拔管时间及苏醒期谵妄情况。
与C组相比，B组患儿七氟烷消耗量显著降低（17.2±2.6 vs. 27.5±5.0mL，P<0.001），芬太尼消耗量也显著降低（2.2±0.5 vs. 3.2±0.6μg/kg，P<0.001）。B组拔管时间显著缩短（3.9±0.7 vs. 9.5±1.6分钟，P<0.001）。C组在5分钟和10分钟时的小儿麻醉苏醒期谵妄量表（PAED）评分显著更高（P<0.001）。C组术中心率显著更高。C组在15分钟、60分钟和75分钟时平均动脉压显著更高。
术前经黏膜应用局部麻醉药进行SPGB可显著降低腭裂修复术患儿的七氟烷和芬太尼需求量，血流动力学稳定，恢复更快，苏醒期谵妄更少。
