Chhibber A K, Perkins F M, Rabinowitz R, Vogt A W, Hulbert W C
Department of Anesthesiology, University of Rochester Medical Center, New York, USA.
J Urol. 1997 Sep;158(3 Pt 2):1156-9. doi: 10.1097/00005392-199709000-00118.
It has been well established that a dorsal penile nerve block immediately after surgery decreases postoperative pain in children undergoing hypospadias repair. However, to our knowledge the efficacy of a penile block immediately before versus immediately after surgery for postoperative pain control has not been previously studied in such children.
We evaluated 98 healthy boys 6 months to 12 years old undergoing hypospadias repair. General anesthesia was induced and maintained in a standard fashion. Patients were randomly assigned to receive a penile block with the same total dose of bupivacaine at the completion of surgery, before the incision or before and at the completion of surgery. No other analgesic was administered intraoperatively. Pain was assessed using a modified objective pain-discomfort scale at 15 minutes, and 3, 12 and 24 hours after surgery. The number of doses of acetaminophen required to control postoperative pain was also recorded.
Pain scores were defined in a range of 0-no pain to 6-greatest pain. During recovery median pain scores in the 30, 36 and 32 boys who received a penile block after, before, and before and after surgery were 3, 1.5 and 0 at 15 minutes; 2.5, 1 and 0 at 3 hours; 3, 2 and 0 at 12 hours; and 1, 0 and 0 at 24 hours, respectively. There was no difference in acetaminophen doses required 15 minutes and 3 hours postoperatively in the 3 groups. By 12 hours after surgery the number of acetaminophen doses required for pain control was significantly lower in the before and after, and before groups than in the after group. By 24 hours boys in the before and after group required significantly fewer doses of analgesics than those in the after and before groups. There was no statistically significant difference between the after and before groups.
Two penile blocks performed at the beginning and conclusion of hypospadias repair, respectively, provide better postoperative pain control than 1 penile block done before or after surgery (p < 0.05). These patients require less analgesic than those who receive a penile block only before or only after surgery.
阴茎背神经阻滞在术后即刻进行可减轻尿道下裂修复术患儿的术后疼痛，这一点已得到充分证实。然而，据我们所知，在此类患儿中，术前即刻与术后即刻进行阴茎阻滞对术后疼痛控制的效果此前尚未被研究过。
我们评估了98名年龄在6个月至12岁之间接受尿道下裂修复术的健康男孩。采用标准方式诱导并维持全身麻醉。患者被随机分配在手术结束时、切口前或切口前及结束时接受相同总剂量布比卡因的阴茎阻滞。术中未给予其他镇痛药。在术后15分钟、3小时、12小时和24小时，使用改良的客观疼痛不适量表评估疼痛情况。还记录了控制术后疼痛所需对乙酰氨基酚的剂量。
疼痛评分范围为0（无疼痛）至6（最剧烈疼痛）。在术后接受阴茎阻滞的30名男孩、术前接受阴茎阻滞的36名男孩以及术前和术后均接受阴茎阻滞的32名男孩中，恢复期间15分钟时的中位疼痛评分分别为3、1.5和0；3小时时分别为2.5、1和0；12小时时分别为3、2和0；24小时时分别为1、0和0。三组患者术后15分钟和3小时所需对乙酰氨基酚剂量无差异。术后12小时，术前和术后组以及术前组控制疼痛所需对乙酰氨基酚剂量显著低于术后组。到术后24小时，术前和术后组男孩所需镇痛药剂量显著少于术后组和术前组。术后组和术前组之间无统计学显著差异。
在尿道下裂修复术开始时和结束时分别进行两次阴茎阻滞，比在手术前或手术后进行一次阴茎阻滞能提供更好的术后疼痛控制（p < 0.05）。与仅在术前或仅在术后接受阴茎阻滞的患者相比，这些患者所需镇痛药更少。
