地塞米松+罗哌卡因髂筋膜神经阻滞联合全麻在小儿先天性髋关节脱位矫形术中的效果分析

樊超; 许晓东; 孙全鹏; 杨晓宇; 全立新; 高俊伟; 白伟杰

doi:10.16766/j.cnki.issn.1674-4152.003593

地塞米松+罗哌卡因髂筋膜神经阻滞联合全麻在小儿先天性髋关节脱位矫形术中的效果分析

doi: 10.16766/j.cnki.issn.1674-4152.003593

1.
郑州市骨科医院麻醉科，河南郑州 450052
2.
河南省人民医院围术期医学科，河南郑州 450003
3.
郑州大学第一附属医院围术期医学科，河南郑州 450044
4.
郑州大学第三附属医院产科，河南郑州 450052

基金项目:

河南省科技攻关项目 LHGJ20200758

河南省医学教育研究项目 Wjlx2021313

详细信息

通讯作者:
杨晓宇，E-mail：yxydyx86@163.com

中图分类号: R726.2 R614
计量
- 文章访问数: 115
- HTML全文浏览量: 39
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-08
- 网络出版日期: 2024-09-05

Study on the effect of dexamethasone and ropivacaine iliac fascia nerve block combined with general anesthesia in corrective surgery for congenital hip dislocation in children

1.
Department of Anesthesiology, Zhengzhou Orthopedic Hospital, Zhengzhou, Henan 450052, China

摘要

摘要: 目的评价地塞米松+罗哌卡因髂筋膜神经阻滞用于小儿先天性髋关节脱位矫形手术围手术期的镇痛效果。方法选择2019年2月—2022年8月于郑州市骨科医院行先天性髋关节脱位矫形术的患儿90例，采用随机数字表法分为3组：全麻组(C组，30例)、罗哌卡因-全麻组(L组，30例)和地塞米松+罗哌卡因-全麻组(D组，30例)。全麻后，L组超声引导下注射0.25%罗哌卡因1 mL/kg。D组超声引导下注射0.2 mg/kg地塞米松+0.25%罗哌卡因1 mL/kg。术后疼痛采用酮咯酸氨丁三醇、氢吗啡酮补救。记录3组患儿术中麻醉药物用量和苏醒情况，术后痛觉阻滞时间、补救药物应用情况。结果与C组丙泊酚和瑞芬太尼用量[(336±35)mg、(383±35)μg]比较，L组[(197±28)mg、(188±22)μg]和D组[(194±32)mg、(187±28)μg]均减少(P＜0.001)；L组和D组苏醒时间、拔管时间、麻醉恢复室停留时间均缩短(P＜0.001)。C组[(27.5±11.2)min]、L组[(357.4±102.7)min]术后痛觉阻滞时间均短于D组[(485.2±120.6)min，P＜0.001]。D组、L组术后氢吗啡酮使用率均低于C组(P＜0.001)；D组恶心呕吐发生率低于C组、L组(P＜0.017)。结论地塞米松+罗哌卡因腹股沟上髂筋膜阻滞联合全麻用于小儿先天性髋关节脱位矫形手术，痛觉阻滞时间延长，抑制了围手术期痛敏反应，利于实现围手术期舒适化医疗。
- 先天性髋关节脱位 /
- 小儿 /
- 髂筋膜神经阻滞 /
- 超声引导
Abstract: Objective To assess the analgesic efficacy of dexamethasone combined with ropivacaine iliac fascial nerve block in pediatric patients undergoing orthopedic surgery for congenital hip dislocation. Methods Ninety children who underwent corrective surgery for congenital hip dislocation at Zhengzhou Orthopedic Hospital from February 2019 to August 2022 were selected and divide into three groups (n=30) using a random number table: general anesthesia group (Group C), ropivacaine general anesthesia group (Group L), and dexamethasone + ropivacaine general anesthesia group (Group D). After general anesthesia, group L received an injection of 0.25% ropivacaine 1 mL/kg under ultrasound guidance. Group D received an injection of 0.2 mg/kg dexamethasone and 0.25% ropivacaine 1 mL/kg under ultrasound guidance. Postoperative pain was managed with ketorolac tromethamine and hydromorphone. The dosage and awakening status of anesthesia drugs during surgery, postoperative pain blockade time, and application of remedial drugs were recorded for the three groups of pediatric patients. Results Compared to the dosage of propofol and remifentanil in Group C [(336±35) mg, (383±35) μg], the dosages in the Group L [(197±28) mg, (188±22) μg] and group D [(194±32) mg, (187±28) μg] were significantly reduced (P < 0.001). The awakening time, extubation time, and post-anesthesia care unit residence time were also shortened (P < 0.001). The postoperative pain blockade time in Group C [(27.5±11.2) min] and Group L [(357.4±102.7) min] was shorter than that in Group D [(485.2±120.6) min, P < 0.001]. The postoperative use rate of hydromorphone in Group D was lower than that in Group C and Group L (P < 0.001). Additionally, the incidence of nausea and vomiting in Group D was lower than that in Group C and Group L (P < 0.017). Conclusion The combination of dexamethasone and ropivacaine in a supra-inguinal fascia iliaca block with general anesthesia is used in the correction surgery for congenital hip dislocation in children. This approach prolongs pain blockade time and suppresses perioperative pain sensitivity reactions, contributing to more comfortable perioperative medical care.
- Congenital hip dislocation /
- Children /
- Fascial nerve block of the iliacia /
- Ultrasound guidance

HTML全文

表 1 3组行DDH矫形术的患儿一般情况及手术时间等指标比较

Table 1. Comparison of general conditions, operation time, and other indicators among three groups of children undergoing DDH orthopedic surgery

组别	例数	性别(男/女, 例)	年龄(x ±s, 岁)	BMI(x ±s)	手术时间(x ±s, min)	术中出血量(x ±s, mL)
C组	30	5/25	4.8±1.5	15.2±1.9	120.8±21.5	85±9
L组	30	6/24	4.6±1.3	14.8±2.1	120.8±18.2	83±10
D组	30	6/24	4.5±1.6	14.3±2.2	119.8±15.3	86±11
统计量		0.145^a	0.323^b	1.423^b	0.029^b	0.695^b
P值		0.930	0.725	0.247	0.971	0.502
注：^a为χ²值，^b为F值。

下载: 导出CSV

表 2 3组行DDH矫形术的患儿苏醒情况及术中麻醉药物用量比较(x ±s)

Table 2. Comparison of recovery and intraoperative anesthetic drug dosage among three groups of children undergoing DDH orthopedic surgery (x ±s)

组别	例数	瑞芬太尼用量(μg)	丙泊酚用量(mg)	苏醒时间(min)	气管拔管时间(min)	PACU停留时间(min)
C组	30	383±35	336±35	14.2±3.2	16.2±2.9	32.5±4.3
L组	30	188±22^a	197±28^a	8.4±2.6^a	9.7±2.8^a	19.2±2.9^a
D组	30	187±28^a	194±32^a	7.9±2.3^a	9.2±3.1^a	18.9±3.2^a
F值		459.940	195.322	49.516	53.074	146.179
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：与C组比较，^aP＜0.05。

下载: 导出CSV

表 3 3组行DDH矫形术的患儿术后痛觉阻滞时间、酮咯酸氨丁三醇、氢吗啡酮使用情况比较

Table 3. Comparison of postoperative pain block time, ketorolac tromethamine, and hydromorphone useage among three groups of children undergoing DDH orthopedic surgery

组别	例数	痛觉阻滞时间(x ±s, min)	酮咯酸氨丁三醇用量(x ±s, mg)	氢吗啡酮用量(x ±s, mg)	氢吗啡酮使用率[例(%)]
C组	30	27.5±11.2	35.4±2.5	0.78±0.13	26 (86.7)
L组	30	357.4±102.7^a	21.1±3.5^a	0.36±0.07^a	13(43.3)^a
D组	30	485.2±120.6^ab	9.4±1.5^ab	0.11±0.05^ab	5(16.7)^a
统计量		199.065^c	735.455^c	424.568^c	29.970^d
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与C组比较, ^aP＜0.05；与L组比较, ^bP＜0.05。^c为F值, ^d为χ²值。计数资料组间两两比较校正检验水准α=0.017。

下载: 导出CSV

表 4 3组行DDH矫形术的患儿术后不良反应发生率比较[例(%)]

Table 4. Comparison of postoperative adverse reaction rates among three groups of children undergoing DDH orthopedic surgery[cases (%)]

组别	例数	恶心呕吐	皮肤瘙痒	尿潴留
C组	30	9(30.0)	3(10.0)	1(3.3)
L组	30	4(13.3)	1(3.0)	0
D组	30	1(3.3)^a	0	0
P值		0.018^b	0.318^b	0.999^b
注：与C组比较，^aP＜0.017。^b为采用Fisher精确检验。

下载: 导出CSV

参考文献(18)

[1]	SIOUTIS S, KOLOVOS S, PAPAKONSTANTINOU M E, et al. Developmental dysplasia of the hip: a review[J]. J Long Term Eff Med Implants, 2022, 32(3): 39-56. doi: 10.1615/JLongTermEffMedImplants.2022040393
[2]	YANG D, WANG S Q, KE C H, et al. Establishment of pediatric developmental dysplasia of the hip biobank: Shanghai Children ' s Hospital experience[J]. Cell Tissue Bank, 2022, 23(3): 581-590. doi: 10.1007/s10561-022-09995-3
[3]	CHEN Y H, MIN C T, WANG Q Q, et al. Procedural pain in hospitalized children in a Chinese Children ' s Hospital[J]. Pain Manag Nurs, 2021, 22(3): 414-422. doi: 10.1016/j.pmn.2020.11.009
[4]	张广磊, 张平, 冯学会, 等. 超声引导下骶管阻滞在小儿腹腔镜下腹股沟疝手术中的应用[J]. 中华全科医学, 2022, 20(6): 982-985. doi: 10.16766/j.cnki.issn.1674-4152.002504 ZHANG G L, ZHANG P, FENG X H, et al. Application of ultrasound-guided sacral canal block in laparoscopic inguinal hernia surgery in children[J]. Chinese Journal of General Practice, 2022, 12(6): 982-985. doi: 10.16766/j.cnki.issn.1674-4152.002504
[5]	安小凤, 方良勤, 吴丹. 超声引导下腰骶丛神经阻滞联合全麻在高龄患者髋关节置换术中的临床应用[J]. 中华全科医学, 2021, 19(2): 186-188, 311. doi: 10.16766/j.cnki.issn.1674-4152.001763 AN X F, FANG L Q, WU D. Clinical application of ultrasound-guided low sacral plexus nerve block combined with general anesthesia in hip replacement for elderly patients[J]. Chinese Journal of General Practice, 2021, 19(2): 186-188, 311. doi: 10.16766/j.cnki.issn.1674-4152.001763
[6]	黄宇捷, 陈钱正, 黄红华. 超声引导下罗哌卡因复合地塞米松神经阻滞在老年胫腓骨远端骨折手术中的应用[J]. 中国临床医学, 2023, 30(1): 116-120. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202301016.htm HUANG Y J, CHEN Q Z, HUANG H H. Application of ultrasound-guided ropivacaine combined with dexamethasone nerve block in elderly patients with distal tibiofibular fracture[J]. Chinese Journal of Clinical Medicine, 2023, 30(1): 116-120. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202301016.htm
[7]	KANTAKAM P, MAIKONG N, SINTHUBUA A, et al. Cadaveric investigation of the minimum effective volume for ultrasound-guided suprainguinal fascia iliaca block[J]. Reg Anesth Pain Med, 2021, 46(9): 757-762. doi: 10.1136/rapm-2021-102563
[8]	CRELLIN D J, HARRISON D, SANTAMARIA N, et al. Comparison of the psychometric properties of the FLACC scale, the MBPS and the observer applied visual analogue scale used to assess procedural pain[J]. J Pain Res, 2021, 14: 881-892. doi: 10.2147/JPR.S267839
[9]	PENG T C, QU S Q, DU Z, et al. A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment[J]. J Pain Res, 2023, 16: 1185-1196. doi: 10.2147/JPR.S397064
[10]	DEMEULENAERE M, JANSSENS G P L, VAN BEEK N, et al. Optimizing rapid recovery after anterior hip arthroplasty surgery: a comparative study of fascia iliaca compartment block and local infiltration analgesia[J]. J Arthroplasty, 2022, 37(7): 1338-1347. doi: 10.1016/j.arth.2022.03.040
[11]	KAMY B, NAMRATA S, MIRLEY R S, et al. Comparison of suprainguinal approach with infrainguinal approach of fascia iliaca compartment block for postoperative analgesia[J]. Indian J Anaesth, 2022, 66(6): 294-299.
[12]	QIAN Y Y, GUO Z Y, HUANG J J, et al. Electromyographic comparison of the efficacy of ultrasound-guided suprainguinal and infrainguinal fascia iliaca compartment block for blockade of the obturator nerve in total knee arthroplasty: a prospective randomized controlled trial[J]. Clin J Pain, 2020, 36(4): 260-266. doi: 10.1097/AJP.0000000000000795
[13]	ZHENG T, HU B, ZHENG C Y, et al. Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound-guided supra-inguinal fascia iliaca compartment block[J]. BMC Anesthesiol, 2021, 21(1): 75. DOI: 10.1186/s12871-021-01296-8.
[14]	YANG J, ZHAO M, ZHANG X R, et al. Ropivacaine with dexmedetomidine or dexamethasone in a thoracic paravertebral nerve block combined with an erector spinae plane block for thoracoscopic lobectomy analgesia: a randomized controlled trial[J]. Drug Des Devel Ther, 2022, 16: 1561-1571. doi: 10.2147/DDDT.S366428
[15]	XUAN C L, YAN W, WANG D, et al. The facilitatory effects of adjuvant pharmaceutics to prolong the duration of local anesthetic for peripheral nerve block: a systematic review and network meta-analysis[J]. Anesth Analg, 2021, 133(3): 620-629. doi: 10.1213/ANE.0000000000005640
[16]	ZENG Y, WANG Q R, HU J, et al. Adding dexamethasone to adductor canal block combined with iPACK block improve postoperative analgesia of total knee arthroplasty[J]. Clin J Pain, 2022, 38(9): 575-581. doi: 10.1097/AJP.0000000000001056
[17]	DESAI N, KIRKHAM K R, ALBRECHT E. Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review[J]. Anaesthesia, 2021, 76(1): 100-109.
[18]	LI F, YANG Q, YI J R, et al. The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia[J]. J Orthop Surg Res, 2023, 18(1): 181. DOI: 10.1186/s13018-023-03540-y.