耳部整形术后镇痛：区域神经阻滞与耳部局部麻醉浸润

Analgesia after otoplasty: regional nerve blockade vs local anaesthetic infiltration of the ear.

作者信息

Cregg N, Conway F, Casey W

机构信息

Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland.

出版信息

Can J Anaesth. 1996 Feb;43(2):141-7. doi: 10.1007/BF03011255.

DOI:10.1007/BF03011255

PMID:8825539

Abstract

PURPOSE

Children scheduled to undergo otoplasty experience severe pain postoperatively. Nausea and vomiting is also a problem. This study was designed to compare two analgesic techniques (i) regional nerve blockade (ii) local anaesthetic infiltration, with respect to quality and duration of analgesia, opioid requirements and the incidence of postoperative nausea and vomiting (PONV).

METHODS

Forty three children, ASA I-II, aged 3-15 yr, were studied and followed for 24 hr postoperatively. Patients were randomised into two groups. Patients in Group A received local infiltration with lidocaine 1% with adrenaline 1:200,000 0.4 ml.kg-1 (n = 21). Patients in Group B (n = 22) received nerve blockade, bupivacaine 0.5%, 0.4 ml.kg-1. No other form of analgesia was used intraoperatively. Quality and duration of analgesia were assessed using pain and sedation scores recorded by a blinded observer at 0, 5, 10, 15, 30, 45 min with Recovery Room, and at 0, 30, 60, 90, 120, 180, 240, 360, 480 min on the ward. Pain score > 6 was treated with fentanyl 1 microgram.kg-1 iv (recovery) and morphine 0.2 mg.kg-1 im or mefenamic acid 8 mg.kg-1 po on the ward. Time to first supplemental analgesia was noted. Mean duration of analgesia was 8.6 (1.1-24) hr, Group A and 10.5 (1.3-24) hr, Group B (P > 0.7). 24% per cent of children (Group A) and 27% (Group B) required no supplemental analgesia (P > 0.6). The degree of pain control resulted in a low requirement for opioids, Group A: 24%, Group B: 14% (P:NS). The overall incidence of PONV was 43% (Group A) and 36% (Group B) (P:NS): PONV correlated with opioid use. There were no differences between the groups with regard to pain/sedation scores, quality/duration of analgesia, opioid requirements and incidence of PONV.

CONCLUSION

Both techniques provided excellent postoperative analgesia. Lidocaine 1% infiltration (adrenaline 1:200,000) has the added advantage of improving surgical field and haemostasis. Thus, we advocate use of the simpler technique.

摘要

目的

计划接受耳部整形手术的儿童术后会经历严重疼痛。恶心和呕吐也是一个问题。本研究旨在比较两种镇痛技术：（i）区域神经阻滞；（ii）局部麻醉药浸润，在镇痛质量和持续时间、阿片类药物需求以及术后恶心呕吐（PONV）发生率方面的差异。

方法

对43例年龄在3 - 15岁、ASA I-II级的儿童进行研究，并在术后随访24小时。患者被随机分为两组。A组患者接受1%利多卡因加1:200,000肾上腺素0.4 ml·kg⁻¹的局部浸润（n = 21）。B组患者（n = 22）接受0.5%布比卡因0.4 ml·kg⁻¹的神经阻滞。术中未使用其他形式的镇痛。镇痛质量和持续时间通过由一名盲法观察者在恢复室0、5、10、15、30、45分钟以及在病房0、30、60、90、120、180、240、360、480分钟记录的疼痛和镇静评分进行评估。疼痛评分>6时，在恢复室静脉注射1微克·kg⁻¹芬太尼，在病房肌肉注射0.2 mg·kg⁻¹吗啡或口服8 mg·kg⁻¹甲芬那酸进行治疗。记录首次补充镇痛的时间。A组镇痛平均持续时间为8.6（1.1 - 24）小时，B组为10.5（1.3 - 24）小时（P>0.7）。24%的儿童（A组）和27%（B组）不需要补充镇痛（P>0.6）。疼痛控制程度导致阿片类药物需求较低，A组：24%，B组：14%（P：无显著性差异）。PONV的总体发生率为43%（A组）和36%（B组）（P：无显著性差异）：PONV与阿片类药物使用相关。两组在疼痛/镇静评分、镇痛质量/持续时间、阿片类药物需求和PONV发生率方面无差异。