Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children
Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children
复制标题
DOI：
10.1111/pan.13085
复制
发表时间：
2017-05-01
影响因子：
1.7
通讯作者：
Morimoto, Yuji
中科院分区：
文献类型：
--
作者：
Uchinami, Yuka;Sakuraya, Fumika;Morimoto, Yuji
背景悬极引导的直肌鞘块和局部麻醉浸润是改善手术中中线切口的儿童术后疼痛的标准选择。然而，没有研究将超声引导的直肌鞘块与接受腹腔镜手术的儿童的局部麻醉浸润进行比较。这项试验的目的是比较超声导管的直肌鞘块的发作与局部麻醉的浸润的发作腹腔镜经皮腹膜外闭合儿童中的闭合。Methodswe进行了观察者盲，随机，前瞻性试验。招募的患者被分配到超声引导的直肠鞘块组或局部麻醉浸润组中。超声引导的直肌鞘块组（n = 17）在后直肠鞘室的每侧0.375％ropivacaine接受超声引导的直肌鞘块。局部麻醉浸润组（n = 17）接受了局部麻醉浸润，0.2mlkg（-1）为0.75％ropivacaine。在到达麻醉后护理单位后0、30、60分钟记录了面部，腿，活动，哭泣和可调节性（FLACC）疼痛评分。这项研究入学的37名患者的征收，34例完成了研究方案。超声引导的直肌鞘块组与局部麻醉浸润组之间的疼痛量表有显着差异（中位数：0，四分位间范围[IQR]：0-1.5，vs中位数：1，IQR 0-5 ，中位数[95％CI]：0-3，p = 0.048），但在30分钟时没有发现显着差异（中值：1， IQR：0-4 vs中位数：6，IQR：0-7，95％CI：0-5，P = 0.061）或60分钟（中位数：0，IQR：0-2：0-2 vs中位数：1，IQR：0，IQR：0 -3，95％CI：-1至1，p = 0.310）。超声引导的直肌鞘块和局部麻醉浸润组之间的麻醉时间没有发现显着差异。在这两组中，均未观察到与程序相关的并发症。关注侧面引导的直肌鞘块是控制腹腔镜外交闭合的儿科患者比局部麻醉液相比，可以更快地控制术后疼痛的方法，因此可以提供临床利益。
BackgroundUltrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery.AimsThe aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.MethodsWe performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 mlkg(-1) of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 mlkg(-1) of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit.ResultsOf the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group.ConclusionUltrasound-guided rectus sheath block is a quicker way to control postoperative pain for pediatric patients undergoing laparoscopic extraperitoneal closure than local anesthetic infiltration, and thus may provide a clinical benefit.