Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip
Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip
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DOI：
10.1080/02844319950159668
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发表时间：
1999-03-01
影响因子：
--
通讯作者：
Grewal, S
中科院分区：
文献类型：
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作者：
Prabhu, KPK;Wig, J;Grewal, S
唇裂修复术是婴幼儿常见的一种手术，要求患儿在术后期间保持无痛，这样才不会影响手术微妙部位的完整性。本研究旨在比较0.125%布比卡因作为双侧眶下神经阻滞与切口处注入相同的局部麻醉剂用于唇裂修复术后镇痛的效果和持续时间。这是一项随机、双盲、前瞻性研究，研究对象为30名4-20个月大的儿童(ASA 1级)。A组(n=15)采用0.125%布比卡因双侧眶下神经阻滞，B组(n=15)采用同样浓度的布比卡因双侧眶下神经阻滞。在手术前或手术中没有额外的全身镇痛剂。术中监测包括测量心率和血压，术后疼痛缓解使用行为疼痛缓解评分。分别于拔管后0、1、2、4、8、24小时监测心率、呼吸频率和血压。结果显示，术后8h，A组疼痛缓解(评分高于B组)明显优于B组(p<；0.05)。B组术后2小时有明显的止痛需求，而A组仅在术后8小时有明显的止痛需求。两组气管插管时的心率和血压均显著升高，提示虽然两种镇痛方法都足以预防皮肤切开的反应，但不能替代术中充分的全身镇痛。结论：0.125%布比卡因眶下神经阻滞在唇裂修复术中的止痛效果优于切缘浸润法，且持续时间更长。
Cleft lip repair is a common operation in infants and requires that the child is pain-free during the postoperative period so that handling does not affect the integrity of the delicate surgical site. This study was designed to compare the efficacy and duration of effect of 0.125% bupivacaine given preoperatively as a bilateral infraorbital nerve block with peri-incisional infiltration of the same local anaesthetic for postoperative analgesia in cleft lip repair. It was a randomised, double blind, prospective study in 30 children aged 4-20 months (ASA grade 1). After a standard induction, group A (n = 15) were given a bilateral infraorbital nerve block with 0.125% bupivacaine and group B (n = 15) had peri-incisional infiltration with the same solution. No additional systemic analgesics were given before or during the operation. Intraoperative monitoring comprised measurement of heart rate and blood pressure and postoperatively pain relief was recorded using a behavioural pain relief score. The heart rate, respiratory rate, and blood pressure were also monitored at 0, 1, 2, 4, 8, and 24 hours after tracheal extubation. The results showed that group A had significantly better pain relief (higher scores) than group B for eight hours postoperatively (p < 0.05). The analgesic requirement in group B became significant at two hours postoperatively, while group A had significant analgesic requirements only after eight hours. The significant rise in heart rate and blood pressure that accompanied tracheal intubation in both groups suggested that while both methods of analgesia may be adequate to prevent responses to skin incision, they do not substitute for adequate systemic analgesia during the operation. We conclude that infraorbital nerve block with 0.125% bupivacaine provides better and more prolonged analgesia than peri-incisional infiltration in cleft lip repair.