Wu Lei, Wei Siwei, Xiang Zhen, Yu Eryou, Chen Zheng, Du Zhen, Qu Shuang Quan
Department of Anesthesiology, Hunan Children's Hospital, Changsha, China.
Front Med (Lausanne). 2023 Oct 6;10:1250039. doi: 10.3389/fmed.2023.1250039. eCollection 2023.
Few studies have examined the effect of epidural block on surgical conditions during pediatric subumbilical laparoscopic surgery involving a supraglottic airway (SGA). This study investigated the surgical condition scores for such procedures in cases where neuromuscular block, epidural block, or neither was used.
A total of 150 patients aged 3-12 years undergoing laparoscopic orchiopexy with a ProSeal SGA device were randomly allocated to one of three groups: the control group (did not receive neuromuscular block and epidural block), the NMB group [received a neuromuscular block (train-of-four 1-2 twitches) using rocuronium], or the EDB group (received an epidural block using ropivacaine). The primary outcome was the quality of surgical conditions evaluated with the Leiden-Surgical Rating Scale by the blinded surgeon. The secondary outcome measures included intraoperative hemodynamic data (including mean arterial pressure and heart rate), the SGA device removal time, the PACU discharge time, the pain score in the PACU and intraoperative adverse events (including bradycardia, hypotension, peak airway pressure > 20 cmHO, and poor or extremely poor surgical conditions occurred during the operation). Statistical analysis was performed with one-way analysis of variance, the Kruskal-Wallis test, the chi-square test or Fisher's exact test. Bonferroni corrections for multiple comparisons were made for primary and secondary outcomes.
Surgical condition scores were significantly higher in the NMB and EDB groups than in the control group (median difference: 0.8; 95% confidence interval [CI], 0.5-1.0; < 0.0001; and median difference: 0.7; 95% CI, 0.5-0.8; < 0.0001, respectively). Blood pressure and heart rate were significantly lower in the EDB group than in the other two groups ( < 0.0001 and = 0.004). Patients in the EDB group had significantly lower pain scores during PACU than those in the other two groups ( < 0.0001). The sufentanil dose was lower in the EDB group than in the other two groups ( = 0.001).
Epidural block can improve surgical conditions during pediatric subumbilical laparoscopic surgery involving a SGA to a degree comparable to that with moderate neuromuscular block.
很少有研究探讨在小儿脐下腹腔镜手术中使用声门上气道（SGA）时硬膜外阻滞对外科手术条件的影响。本研究调查了在使用或不使用神经肌肉阻滞或硬膜外阻滞的情况下此类手术的手术条件评分。
总共150例年龄在3至12岁之间、使用ProSeal SGA装置进行腹腔镜睾丸固定术的患者被随机分配到三组中的一组：对照组（未接受神经肌肉阻滞和硬膜外阻滞）、NMB组[使用罗库溴铵接受神经肌肉阻滞（四个成串刺激为1至2次颤搐）]或EDB组（使用罗哌卡因接受硬膜外阻滞）。主要结局是由 blinded 外科医生使用莱顿手术评分量表评估的手术条件质量。次要结局指标包括术中血流动力学数据（包括平均动脉压和心率）、SGA装置移除时间、PACU出院时间、PACU中的疼痛评分以及术中不良事件（包括心动过缓、低血压、气道峰压>20 cmH₂O以及手术过程中出现的手术条件差或极差）。采用单因素方差分析、Kruskal-Wallis检验、卡方检验或Fisher精确检验进行统计分析。对主要和次要结局进行多重比较时采用Bonferroni校正。
NMB组和EDB组的手术条件评分显著高于对照组（中位数差异：0.8；95%置信区间[CI]，0.5 - 1.0；P < 0.0001；以及中位数差异：0.7；95%CI，0.5 - 0.8；P < 0.0001，分别）。EDB组的血压和心率显著低于其他两组（P < 0.0001和P = 0.004）。EDB组患者在PACU期间的疼痛评分显著低于其他两组（P < 0.0001）。EDB组的舒芬太尼剂量低于其他两组（P = 0.001）。
在涉及SGA的小儿脐下腹腔镜手术中，硬膜外阻滞可将手术条件改善到与中度神经肌肉阻滞相当的程度。
