Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children?
Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children?
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DOI：
10.1111/j.1460-9592.2010.03405.x
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发表时间：
2010-10-01
影响因子：
1.7
通讯作者：
Hennart, Danielle
中科院分区：
文献类型：
--
作者：
Faraoni, David;Gilbeau, Anick;Hennart, Danielle
背景：阴茎神经阻滞(PNB)是一种成熟的包皮环切术，它需要在阴茎背神经附近注射局部麻醉剂。本研究的目的是比较超声引导下PNB和基于里程碑的经典技术(LBT)在儿童包皮环切术中的疗效。方法：将40名1-14岁的男孩随机分为超声引导组和基于里程碑的组。所有患者均接受标准的七氟醚麻醉。每组患者均接受罗比卡因阴茎阻滞，每侧0.75 mg中心点kg-1，阴茎根部中心点kg-1 0.05 mg。比较两组的术中麻醉失败率、麻醉时间、术后疼痛程度、首次注射扑热息痛所需剂量的时间、首次排尿时间、平均住院时间。结果：两组背侧PNB的失败率差异无统计学意义(P=0.5)。在到达PACU时(P<；0.01)和30分钟后(P<；0.01)，在术后疼痛评分方面，超声引导下PNB的疗效优于LBT。超声引导下注射扑热息痛的时间也有所延长(P<；0.0001)，但超声引导下的麻醉诱导至手术结束的时间延长了10min(P=0.001)。结论：在术后1小时内的疼痛程度和术后镇痛达到首次要求的时间上，超声引导下的PNB均优于LBT。
P>Background:Penile nerve block (PNB) is a well-established technique used for circumcision; it requires the injection of local anesthetics close to the dorsal nerve of the penis. The goal of this study was to compare the efficacy of ultrasound-guided PNB versus the classical landmark-based technique (LBT) in children undergoing circumcision.Methods:Forty boys, aged 1-14 years old that were scheduled for circumcision were randomly assigned to ultrasound-guided and landmark-based groups. All patients were placed under standard anesthesia with sevoflurane. In each group, patients received the penile block with ropivacaine, 0.75 mg center dot kg-1 per side, and 0.05 mg center dot kg-1 at the penis base. Groups were compared for intraoperative failure rate of the block, anesthesia time, postoperative pain scale, time of first required dose of paracetamol, time to first micturition, and average duration of stay in the postanesthesia care unit.Results:The failure rate of dorsal PNB was not statistically different between groups (P = 0.5). Ultrasound guidance improved the efficacy of the PNB compared to the LBT in terms of postoperative pain scores on arrival in the PACU (P < 0.01) and after 30 min (P < 0.01). The ultrasound-guided technique also delayed the time to the first paracetamol dose administration (P < 0.0001), but the duration of the procedure, defined as the time between anesthesia induction and the end of surgery, was increased by 10 min in the US-guided group (P = 0.001).Conclusion:Ultrasound-guided PNB improved the efficacy of the block compared with the LBT in terms of the postoperative pain during the first postoperative hour and the time to the first requirement for postoperative analgesia.