article: Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery - Minerva Pediatrics 2021 Dec 21 - Minerva Medica - Journals

目的 观察超声引导阴茎背神经阻滞联合右美托咪定滴鼻预先镇静镇痛用于小儿包皮环切术的可行性及有效性.方法 选取拟行包皮环切术患儿90例,ASA分级Ⅰ级,年龄3～10岁,体重15～45 kg,采用随机数字表法将其分为3组(n=30),右美托咪定滴鼻组(DC组)、超声引导阴茎背神经阻滞组(DL组)和超声引导阴茎背神经阻滞联合右美托咪啶滴鼻组(DD)组.3组患儿均采用七氟烷吸入喉罩全身麻醉,保留自主呼吸的方法.DL组和DD组术前行超声引导阴茎背神经阻滞,注入0.25％罗哌卡因0.2 ml/kg;DC与DD组术前30 min经鼻滴入右美托咪定1μg/kg.采用诱导期合作度量表(ICC)对患儿七氟烷吸入诱导合作程度评分,记录术中镇痛不全发生情况、苏醒时间、住院时间、术后首次使用镇痛药时间、术后24 h内镇痛药物使用情况、恶心呕吐、躁动、心动过缓及镇静过度等不良反应发生情况以及术后24 h父母满意度评分.结果 与DD组比较,DC组和DL组患儿术中镇痛不全发生率增加,术后镇痛药物使用率、术后躁动及恶心呕吐发生率增加,术后首次使用镇痛药物时间缩短,苏醒时间及住院时间延长,父母满意度降低(P<0.05);与DC组比较,DL组患儿苏醒时间缩短,术后首次使用镇痛药物时间延长(P<0.05);与DL组比较,DC组和DD组ICC评分降低(P<0.05);3阻患儿心动过缓及镇静过度发生率比较差异无统计学意义(P>0.05).结论 超声引导阴茎背神经阻滞联合右美托咪定滴鼻可安全有效的用于包皮环切术患儿,且镇痛效果显著,不良反应发生率低,缩短住院时间加速术后康复.

Objective:To compare the different optimized anesthesia strategies in pediatric patients undergoing hypospadias surgery.Methods:Ninety pediatric patients with distal hypospadias undergoing Duckett operation, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged 1-6 yr, weighing 10-25 kg, were divided into 3 groups ( n=30 each) using a random number table method: caudal block combined with general anesthesia group (group CG), neurostimulator-guided pudendal nerve block combined with general anesthesia group (group PG) and ultrasound-guided dorsal penile nerve block combined with general anesthesia group (group DPG). Anesthesia was induced with propofol-fentanyl, patients were ventilated through the laryngeal mask and maintained spontaneous breathing, and anesthesia was maintained with sevoflurane.The corresponding regional block was performed in each group, and block was performed with 0.25% ropivacaine 1, 0.25 and 0.15 ml/kg in CG, PG and DPG groups, respectively.The consumption of ropivacaine, occurrence of insufficient analgesia during operation, emergence time, duration of post-anesthesia care unit stay, time of the first requirement for analgesics, requirement for analgesics within 24 h after operation, occurrence of postoperative agitation, nausea and vomiting and lower extremity motor block, and patients′ satisfaction score at 24 h after operation were recorded. Results:Compared with group CG, the consumption of ropivacaine was significantly reduced, the time of the first requirement for analgesics was prolonged, the postoperative requirement for analgesics was decreased, duration of post-anesthesia care unit stay was shortened, the incidence of lower extremity motor block was decreased, and patients′ satisfaction score was increased in group PG and group DPG, and the incidence of nausea and vomiting was decreased in group DPG ( P<0.05). Compared with group PG, the consumption of ropivacaine was significantly reduced, and the time of the first requirement for analgesics was shortened in group DPG ( P<0.05). There was no significant difference in the incidence of insufficient analgesia during operation (3% in group DPG) and incidence of postoperative agitation among the three groups ( P>0.05). Conclusion:Ultrasound-guided dorsal penile nerve block combined with general anesthesia provides significant efficacy with a higher safety, and the efficacy is better than that of caudal block combined with general anesthesia and neurostimulator-guided pudendal nerve block general anesthesia when used for pediatric patients undergoing hypospadias surgery.

Objective:To evaluate the improved effects of dexmedetomidine mixed with ropivacaine on pudendal nerve block in the pediatric patients undergoing hypospadias repair.Methods:Sixty pediatric patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 1-6 yr, weighing 10-25 kg, undergoing elective hypospadias repair, were divided into 2 groups by a random number table method: ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR), with 30 cases in each group.All cases received anesthesia induction with sevoflurane inhaled via the laryngeal mask and maintained spontaneous breathing.After laryngeal mask was fixed, pediatric patients underwent pudendal nerve block under ultrasound guidance with 0.2% ropivacaine 0.2 ml/kg in group R, while with 0.2% ropivacaine 0.2 ml/kg and dexmedetomidine 0.75 μg/kg in group DR.The occurrence of insufficient analgesia during operation, emergence time, duration of the first requirement for analgesics, requirement for analgesics, patients′ satisfaction score, and occurrence of adverse reaction such as postoperative agitation, nausea and vomiting, over-sedation, bradycardia, respiratory depression, and parental satisfaction score were recorded.Results:Compared with group R, the duration of the first requirement for analgesics was significantly prolonged, the requirement for paracetamol was decreased, the incidence of agitation and nausea and vomiting was decreased, parental satisfaction scores were increased ( P<0.05), and no significant change was found in the incidence of insufficient analgesia and emergence time in group DR ( P>0.05). No pediatric patients developed adverse reactions such as over-sedation, bradycardia, and respiratory depression in two groups. Conclusion:Dexmedetomidine 0.75 μg/kg mixed with 0.2% ropivacaine can prolong the duration of pudendal nerve block for analgesia with lower incidence of adverse reactions and optimizes the efficacy of pudendal nerve block in pediatric patients undergoing hypospadias repair.