罗哌卡因复合地塞米松双侧眶下神经阻滞对小儿唇裂修复术后疼痛与应激水平的影响

目的 观察罗哌卡因复合地塞米松双侧眶下神经阻滞对小儿唇裂修复术后疼痛与应激水平的影响. 方法 择期行先天性唇裂修复术患儿60例,按随机数字表法分为2组(每组30例):A组,0.25％罗哌卡因1 ml复合地塞米松1 mg配成2ml,于术前行双侧眶下神经阻滞;B组,手术结束后静脉给予地佐辛0.1 mg/kg.观察并记录苏醒期躁动发生率及躁动评分,记录术后2 h(T3)、4 h(T4)、6 h(T5)、8 h(T6)、12 h(T7)、24 h(T8) CRIES(crying,required O2 for SP02＞95％,increased vital signs, expression,sleeplessness)评分.评分≥4分时给予地佐辛0.1 mg/kg肌内注射,记录术后镇痛持续时间与24 h内注射地佐辛总剂量,记录术后副作用.于麻醉前(T1)、手术结束即刻(T2)、T6、T8时采集静脉血测定皮质醇(cortisol,COR)、去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)水平.用放射免疫法测定血清COR浓度,用ELISA法测定血清E和NE的浓度. 结果 A组苏醒期躁动发生率、躁动评分明显低于B组,差异有统计学意义(P＜0.05).A组T4、T5、T6时CRIES评分低于B组,差异有统计学意义(P＜0.05),两组T7、T8时CRIES评分差异无统计学意义(P＞0.05).额外镇痛药需求总量、术后恶心呕吐发生率比较,A组明显低于B组,差异有统计学意义(P＜0.05).平均镇痛时间A组明显长于B组(P＜0.05).T6时A组血清NE、E、COR浓度均低于B组,差异有统计学意义(P＜0.05).T8时血清NE、E、COR浓度接近麻醉前水平. 结论 罗哌卡因复合地塞米松双侧眶下神经阻滞可为唇裂修复术患儿提供有效的术后镇痛,镇痛持续时间明显延长,抑制由于疼痛导致的应激水平的增强.

Effects of ropivacaine combination with dexamethasone for bilateral infraorbital nerve block on postoperative analgesia and stress in pediatric patients with cleft lip repair

Objective This study was conducted to compare the effectiveness,advantages and disadvantages of bilateral infra orbital nerve block using ropivacaine combination with dexamethasone and dezocine for postoperative pain relief and stress level following cheiloplasty.Methods Sixty pediatric patients undergoing cheiloplasty were selected by simple random sampling and were divided into two groups (group B,group A).Group A patients were administered bilateral infra orbital nerve block with 0.25％ ropivacaine 1 ml and 1 mg dexamethasone amount to 2 ml.Group B patients received dezocine 0.1 mg/kg iv.During postoperative period,postoperative agitation,CRIES scores(crying,required O2 for SpO2＞95％,increased vital signs,expression,sleeplessness) at 2 h (T3),4 h(T4),6 h(T5),8 h(T6),12 h(T7),24 h(T8) after surgery and adverse reaction were recorded as well.Supplementary analgesics using and duration between the administration of block/dezocine and the total dose of supplementary analgesics used within 24 h were noted.In order to detect plasma 1eve1 of cortisol (COR),norepinephrine (NE),epinephrine (E),patients blood were collected at time points before anesthesia(T1),at the end of surgery(T2),T6 and Ts after surgery.Results The score of agitation,the CRIES scores at each time point (4-12 h) and the total amounts of supplementary analgesics in group A were lower than in group B.Group A had lower nausea and vomiting rate than group B.Group A had lower concentrations of COR,NE,E at 8th hour than concentrations of group B.Conclusions Bilateral infra orbital nerve block using ropivacaine combination with dexamethasone provided effective postoperative analgesia for children with cleft lip repair and obviously extended analgesia duration.Moreover,this analgesia method effectively attenuated stress response caused by pain.