Wang Yaqin,Chen Peizhang,Zhang Kai,et al.Ultrasound-guided pericapsular nerve group block for pediatric hip surgery:a comparative study with caudal block[J].Journal of Clinical Pediatric Surgery,2024,(03):223-228.[doi:10.3760/cma.j.cn101785-202211036-004]
超声引导下髋关节囊周神经阻滞在小儿髋关节手术中的应用
- Title:
- Ultrasound-guided pericapsular nerve group block for pediatric hip surgery:a comparative study with caudal block
- Keywords:
- Ultrasound-Guided; Pericapsular Nerve Group Block; Developmental Dislocation of The Hip; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较超声引导下髋关节囊周神经(pericapsular nerve group,PENG)阻滞与骶管阻滞在发育性髋关节脱位(developmental dislocation of the hip,DDH)手术患儿中的镇痛效果,初步探讨超声引导下PENG阻滞用于小儿髋关节手术的有效性及安全性。 方法 本研究为前瞻性研究,纳入2022年1月至2023年1月在兰州大学第二医院择期行全身麻醉下单侧DDH开放复位手术的患儿40例,年龄1~5岁,体重10~21 kg,ASA分级Ⅰ~Ⅱ级,将患儿随机分为两组:骶管阻滞组(C组)和髋关节囊周神经阻滞组(P组),每组各20例。患儿均于全身麻醉诱导气管插管后行超声引导下区域阻滞,2组均采用0.2%罗哌卡因1 mL/kg。记录术中舒芬太尼和七氟醚的总用量,术后1 h、2 h、4 h、8 h、12 h、18 h、24 h、36 h、48 h的疼痛行为评分(face legs activity cry consolability,FLACC),术后48 h内首次补救镇痛时间和补救镇痛总量(布洛芬混悬液),术后住院时间、围手术期不良反应发生情况及家长满意度评分。 结果 与C组比较,P组术后首次补救镇痛时间明显延长[4(4,8)h比12(8,40.5)h],补救镇痛布洛芬总量明显减少[(227.0±142.2)mg比(142.0±114.4)mg],家长满意度评分更高[(3.0±0.7)分比(3.4±0.5)分],差异均有统计学意义(P<0.05)。2组术中舒芬太尼消耗量[(9.1±3.4)μg比(8.8±2.6)μg]、七氟醚消耗量[(29.0±4.8)mL比(28.8±5.6)mL]、术后住院时间[(7.2±1.2)d比(6.9±0.9)d]、术后各时点FLACC评分及围手术期不良反应发生情况差异均无统计学意义(P>0.05)。 结论 与骶管阻滞相比,超声引导下PENG阻滞可明显延长DDH患儿术后48 h内的首次补救镇痛时间,减少术后镇痛药物用量,家长满意度更高,值得临床进一步探索应用。
- Abstract:
- Objective To compare the analgesic efficacies of ultrasound-guided pericapsular nerve group (PENG block) versus caudal block in children undergoing surgery for developmental dislocation of the hip (DDH).Methods From January 2022 to January 2023,40 children undergoing unilateral correction of DDH under general anesthesia were selected.With a weight range of (10-21) kg,they were aged (1-5) years.The grade of American Society of Anesthesiologists (ASA) was Ⅰ or Ⅱ.They were randomized into two groups of ultrasound-guided caudal block (C,n=20) and ultrasound-guided pericapsular nerve group block (P,n=20).Nerve block was performed with 0.2% ropivacaine 1 mL/kg after an induction of general anesthesia.Face Legs Activity Cry Consolability (FLACC) scores at 1/2/4/8/12/18/24/36/48h post-operation were evaluated.And consumption of sufentanil/sevoflurane,time to initial rescue analgesia,number of rescue doses within 48h,postoperative length of stay,adverse events and parental satisfaction scores were recorded.Results Initial time of rescue analgesia was significantly longer in group P than that in group C[4(4,8) vs.12(8,40.5) h].Total dosage of ibuprofen for rescue analgesia was significantly less in group P than that in group C[(227.0±142.2) vs.(142.0±114.4) mg].Parental satisfaction score was significantly higher in group P than that in group C[(3.0±0.7)vs.(3.4±0.5) points].No significant inter-group differences existed in intraoperative sufentanil consumption[(9.1±3.4) vs.(8.8±2.6)μg],sevoflurane consumption[(29.0±4.8) vs.(28.8±5.6) mL],postoperative length of stay[(7.2±1.2) vs.(6.9±0.9) day],FLACC score or adverse events.Conclusions As compared with caudal block,ultrasound-guided PENG block may prolong the time to initial rescue analgesia within 48h,lower the dosage of analgesics after DDH surgery and lead to higher parental satisfaction in children.It is worthy of further clinical explorations and applications.
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备注/Memo
收稿日期:2022-11-17。
通讯作者:石翊飒,Email:shiys@lzu.edu.cn