超声引导下右美托咪定混合罗哌卡因FICB对DDH手术的镇痛效果

目的 评价超声引导下右美托咪定混合罗哌卡因髂筋膜间隙阻滞(FICB)对小儿髋部手术的镇痛效果.方法 选取2014年1月至2015年6月在佛山市中医院择期行单侧发育性髋脱位手术的患儿60例,采用随机数字表法,将患者分为两组(各30例).观察组气管插管全麻复合超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB,对照组单用气管插管全麻,两组术后均行芬太尼静脉自控镇痛(PCIA).分别记录术中芬太尼用量,及术后1、2、4、8、12、24、48h的患儿哭泣、呼吸、循环、表情和睡眠疼痛行为学评分,PCIA按压次数,记录不良反应发生情况.结果 与对照组比较,观察组术中芬太尼用量显著减少(49.68±15.29μg vs 68.55±20.03μg,t=4.102,P<0.05),术后各时点CRIES疼痛行为学评分(t=3.644~21.610)及PCIA按压次数(t=3.260~31.770)显著低于对照组(均P<0.05),两组均未见有呼吸抑制.观察组恶心呕吐发生2例(6.67%),对照组恶心呕吐发生6例(20.00%)(χ2=2.308,P=0.129);观察组瘙痒发生1例(3.33%),对照组瘙痒发生4例(13.33%)(χ2=1.964,P=0.161).结论 超声引导下1μg/kg右美托咪定混合0.2%罗哌卡因1mL/kg FICB可有效缓解小儿发育性髋脱位(DDH)手术患者疼痛,且无明显不良反应,镇痛效果确切持久,实施方法 简便易行.

Efficacy of ultrasound-guided fascia iliaca compartment block with dexmedetomidine combining ropivacaine for analgesia in development dislocation of hip surgery

Objective To evaluate the analgesia efficacy of fascia iliaca compartment block (FICB) with dexmedetomidine combining ropivacaine for patients with development dislocation of hip ( DDH) .Methods From January 2014 to June 201560 cases of children accepting elective DDH surgery in Foshan Hospital of TCM were enrolled, and they were graded Ⅰ-Ⅱ according to ASA.Using the random number table method, the patients were divided into two groups ( 30 cases ) .The observation group accepted endotracheal intubation anesthesia with ultrasonic-guided FICB with 1μg/kg dexmedetomidine combining 1mL/kg 0.2%ropivacaine, while control group accepted endotracheal intubation anesthesia only.After surgery, they were treated with fentanylby for controlled intravenous analgesia ( PCIA) .The intraoperative fentanyl dosage, postoperative 1, 2, 4, 8, 12, 24 and 48h of CRIES of pain behavior score, PCIA press number and adverse reactions were recorded. Results Compared with the control group, the intraoperative fentanyl dosage reduced significantly in the observation group (49.68 ±15.29μg vs 68.55 ±20.03μg, t=4.102, P<0.05).Postoperative score of CRIES of pain behavior at each time point and PCIA press number of the observation group were significantly lower than the control group ( t value ranged 3.644-21.610 and 3.260-31.770, respectively, both P<0.05).Both groups had no respiratory depression.Nausea and vomiting occurred in 2 cases (6.67%) in the observation group and 6 cases (20.00%) in the control group (χ2 =2.308, P=0.129).One case (3.33%) had itch in the observation group and 4 cases (13.33%) in the control group (χ2 =1.964, P=0.161).Conclusion Ultrasonic-guided FICB with 1μg/kg dexmedetomidine combining 1mL/kg 0.2% ropivacaine is effective in relieving pain for pediatric DDH surgery, which has no obvious adverse reaction with exact long analgesic effect and easy implementation.