Bansal Teena, Kumar Praveen, Kadian Yogender, Jain Mamta, Singh Anish Kumar, Lal Jatin, Singhal Suresh
Department of Anaesthesiology and Critical Care, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
Department of Paediatric Surgery, Pt B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
Indian J Anaesth. 2024 Aug;68(8):725-730. doi: 10.4103/ija.ija_13_24. Epub 2024 Jul 2.
Caudal block is more frequently used in children for postoperative analgesia. However, its disadvantage is its short duration. Erector spinae plane block (ESPB) at the sacral level can potentially block the pudendal nerve. It may prove an alternative to caudal block for hypospadias repair regarding time to first rescue analgesia.
Fifty children of 2-7 years of age were included. After induction of general anaesthesia, Group I ( = 25) was given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine and Group II ( = 25) was given caudal block with 0.5 ml/kg of 0.25% bupivacaine. Postoperatively at face, leg, activity, cry, consolability (FLACC) score ≥4, rescue analgesia was given using intravenous 15 mg/kg paracetamol. The primary outcome was to compare time to first rescue analgesia, and secondary outcomes were intraoperative haemodynamic parameters, fentanyl consumption, postoperative FLACC score and analgesic consumption in 24 h. Continuous variables were compared using the independent sample -test or Mann-Whitney test, and categorical variables were compared using the Chi-square test.
The mean time to first rescue analgesia was 21.30 (standard deviation [SD]: 3.06) h in Group I and 9.36 (SD: 1.71) h in Group II ( < 0.001) (mean difference -11.94 [95% CI: -13.39, -10.48]). The FLACC score was significantly higher ( < 0.05) postoperatively at 8, 10, 12 and 18 h in Group II. Mean postoperative analgesic consumption was 310.5 (SD: 72.69) mg in Group I and 615.6 (SD: 137.51) mg in Group II ( < 0.001) (mean difference 30.5 [95% CI: 236.41, 373.78]).
Sacral ESPB is better regarding time to first rescue analgesia than caudal block in paediatric patients undergoing hypospadias repair.
在儿童术后镇痛中，骶管阻滞的应用更为频繁。然而，其缺点是作用持续时间短。骶部竖脊肌平面阻滞（ESPB）可能会阻滞阴部神经。就首次补救镇痛时间而言，它可能是尿道下裂修复术骶管阻滞的一种替代方法。
纳入50名2至7岁的儿童。全身麻醉诱导后，第一组（n = 25）接受超声引导下的骶部ESPB，注射1 ml/kg的0.25%布比卡因，第二组（n = 25）接受骶管阻滞，注射0.5 ml/kg的0.25%布比卡因。术后当面部、腿部、活动、哭闹、安慰度（FLACC）评分≥4时，使用静脉注射15 mg/kg对乙酰氨基酚进行补救镇痛。主要结局是比较首次补救镇痛时间，次要结局是术中血流动力学参数、芬太尼用量、术后FLACC评分以及24小时内的镇痛药物用量。连续变量采用独立样本t检验或曼-惠特尼检验进行比较，分类变量采用卡方检验进行比较。
第一组首次补救镇痛的平均时间为21.30（标准差[SD]：3.06）小时，第二组为9.36（SD：1.71）小时（P < 0.001）（平均差值 -11.94 [95%置信区间：-13.39，-10.48]）。第二组术后8、10、12和18小时的FLACC评分显著更高（P < 0.05）。第一组术后镇痛药物平均用量为310.5（SD：72.69）mg，第二组为615.6（SD：137.51）mg（P < 0.001）（平均差值30.5 [95%置信区间：236.41，373.78]）。
在接受尿道下裂修复术的儿科患者中，骶部ESPB在首次补救镇痛时间方面优于骶管阻滞。
