辅助局部麻醉对唇腭裂整复术后镇痛效果的研究

doi:10.7518/gjkq.2022088

摘要/Abstract

摘要：

目的比较全身麻醉术中辅助不同方法的局部麻醉对唇腭裂整复手术术后疼痛的影响。方法将2021年6月—2022年1月在四川大学华西口腔医院唇腭裂外科进行唇腭裂手术的92例2个月~6岁的患儿作为研究对象，根据全身麻醉术中辅助局部麻醉方法的不同分为3组。对照组：术区局部注射生理盐水；浸润组：术区局部浸润麻醉；阻滞组：双侧颧上颌入路上颌神经阻滞麻醉。局部麻醉药为甲磺酸罗哌卡因。3组患者术后2 h时常规给予对乙酰氨基酚混悬滴剂口服镇痛。记录并比较患者全身麻醉过程中七氟烷及舒芬太尼的使用量；记录术前10、5 min、手术开始时及手术开始后30 min内患儿的血压及心率变化；记录患儿回麻醉复苏室后24 h内按一定时间间隔选定的14个观察时间点的疼痛评分及中重度疼痛患儿数量。结果各组间术中七氟烷、舒芬太尼的使用量无显著性差异，舒芬太尼用量为（0.34±0.09） μg·kg^-1；各组间血压及心率变化差异无连续时间点的统计学意义，对照组与浸润组在回麻醉复苏室后3 h时疼痛评分差异有统计学意义，阻滞组与浸润组在回麻醉复苏室后4 h时中重度疼痛人数差异有统计学意义，其余各组间术后疼痛评分及中重度疼痛人数差异无统计学意义；浸润组与阻滞组在回麻醉复苏室后8~16 h出现疼痛评分及中重度疼痛人数上升现象，而对照组在该时间段内呈持续下降趋势。结论在使用常规剂量舒芬太尼（0.34±0.09） μg·kg^-1的全身麻醉条件以及对乙酰氨基酚术后镇痛的条件下，增加局部麻醉不能为唇腭裂患儿带来更好的镇痛效果。

关键词: 唇腭裂整复术, 术后镇痛, 局部浸润麻醉, 上颌神经阻滞, 反跳痛

Abstract:

Objective This study aimed to compare the effect of different local anesthesia during general anesthesia on postoperative pain relief after cleft lip and palate (CLP) surgery. Methods A total of 92 CLP children at the age ran-ging from 2 months to 6 years, who were admitted to the hospital from June 2021 to January 2022, were selected as objects. All patients were divided into three groups as follows: control group, local injection of normal saline preoperative; infiltration group: local infiltration anesthesia preoperative; and block group, bilateral suprazygomatic maxillary nerve block preoperative. All patients received sufentanil for general analgesia and acetaminophen 2 h postoperative. The admi-nistration of sevoflurane and sufentanil during general anesthesia was recorded. Hemodynamic changes in patients 10 min before surgery, 5 min before surgery, at the beginning of surgery, and 30 min after the beginning of surgery were collec-ted. FLACC scores were also recorded from the time of transferring to the post-anesthesia care unit (PACU) to 24 h after surgery. The number of children with mode-rate and severe pain at each observation time was recor-ded. Results No significant difference was found in the dosage of sevoflurane and sufentanil [(0.34±0.09) μg·kg^-1] among all groups. No significant difference was also found in blood pressure and heart rate at continuous time points among all groups. A statistical difference in FLACC score was observed between the control group and the infiltration group at 3 h after transferring to PACU. A statistical difference was also found in the number of patients with moderate and severe pain between the block group and the infiltration group at 4 h after transferring to PACU. The FLACC score and the number of patients with moderate and severe pain increased in the infiltration group and the block group 8-16 h after transferring to PACU, whereas the control group showed a continuous downtrend during this period. Conclusion Under the condition of conventional dose of sufentanil [(0.34±0.09) μg·kg^-1] combined with oral analgesics, local anesthetics showed no obvious advantage in postoperative analgesia.

Key words: cleft lip and palate repair, postoperative analgesia, local anesthesia, maxillary nerve block, rebound pain

中图分类号:

R 782.2

裴玲,曾妮,杨超,何苗,罗强,石冰,郑谦. 辅助局部麻醉对唇腭裂整复术后镇痛效果的研究[J]. 国际口腔医学杂志, 2022, 49(6): 657-662.

Pei Ling,Zeng Ni,Yang Chao,Wang Yan,He Miao,Luo Qiang,Shi Bing. Analgesic effects of local anesthesia after cleft lip and palate repair[J]. Int J Stomatol, 2022, 49(6): 657-662.

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参考文献 21

1	Rodkey EN, Pillai Riddell R. The infancy of infant pain research: the experimental origins of infant pain denial[J]. J Pain, 2013, 14(4): 338-350.
2	Perry M, Tan ZW, Chen J, et al. Neonatal pain: perceptions and current practice[J]. Crit Care Nurs Clin North Am, 2018, 30(4): 549-561.
3	龚彩霞, 严苗, 蒋菲, 等. 学龄前唇腭裂患儿术后疼痛的护理干预效果评价[J]. 华西口腔医学杂志, 2014, 32(3): 263-266.
	Gong CX, Yan M, Jiang F, et al. Nursing intervention and evaluation of postoperative pain in preschool children with cleft lip and palate[J]. West China J Stomatol, 2014, 32(3): 263-266.
4	Prabhu KP, Wig J, Grewal S. Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip[J]. Scand J Plast Reconstr Surg Hand Surg, 1999, 33(1): 83-87.
5	Chiono J, Raux O, Bringuier S, et al. Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children: a prospective, randomized, double-blind study versus placebo[J]. Anesthesiology, 2014, 120(6): 1362-1369.
6	Mostafa MF, Herdan R, Elshazly M. Comparative study of levobupivacaine and bupivacaine for bila-teral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study[J]. Korean J Anesthesiol, 2018, 71(2): 135-140.
7	Abu Elyazed MM, Mostafa SF. Bilateral suprazygomatic maxillary nerve block versus palatal block for cleft palate repair in children: a randomized controlled trial[J]. Egypt J Anaesth, 2018, 34(3): 83-88.
8	Echaniz G, De Miguel M, Merritt G, et al. Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: a double-blind, randomised study[J]. Eur J Anaesthesiol, 2019, 36(1): 40-47.
9	孙绕, 赵文宇, 郝泉水, 等. 中文儿科临床试验疼痛评价量表使用情况调查[J]. 中国循证儿科杂志, 2013, 8(3): 186-191.
	Sun R, Zhao WY, Hao QS, et al. Frequency and use of pain assessment scales in Chinese clinical trials in pediatric population[J]. Chin J Evid Based Pe-diatr, 2013, 8(3): 186-191.
10	Nilsson S, Finnström B, Kokinsky E. The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years[J]. Paediatr Anaesth, 2008, 18(8): 767-774.
11	Crellin DJ, Harrison D, Santamaria N, et al. The psychometric properties of the FLACC scale used to assess procedural pain[J]. J Pain, 2018, 19(8): 862-872.
12	Crellin D, Harrison D, Santamaria N, et al. Comparison of the psychometric properties of the FLACC scale, the MBPS and the observer applied visual a-nalogue scale used to assess procedural pain[J]. J Pain Res, 2021, 14: 881-892.
13	Mesnil M, Dadure C, Captier G, et al. A new approach for peri-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block[J]. Paediatr Anaesth, 2010, 20(4): 343-349.
14	张原源. 婴幼儿疼痛评估方法及其影响因素的临床研究[D]. 开封: 河南大学, 2020.
	Zhang YY. A clinical research about infant pain assessment tools and influencing factors[D]. Kaifeng: Henan University, 2020.
15	王会芹. 舒芬太尼的药理学及临床应用现状[J]. 医学信息, 2016, 29(31): 26-27.
	Wang HQ. Current situation of pharmacology and clinical application of sufentanil[J]. Med Inf, 2016, 29(31): 26-27.
16	张小艳, 李刚, 王令平. 不同剂量舒芬太尼对脊柱手术患者全麻诱导期血流动力学及血浆皮质醇的影响[J]. 山东大学学报(医学版), 2009, 47(6): 76-79.
	Zhang XY, Li G, Wang LP. Effects of different do-sages of Sufentanil in induced general anesthesia period on blood rheology cortisol in spinal operations[J]. J Shandong Univ (Heal Sci), 2009, 47(6): 76-79.
17	Zhang J, Chen L, Sun YY, et al. Comparative effects of fentanyl versus sufentanil on cerebral oxygen sa-turation and postoperative cognitive function in elderly patients undergoing open surgery[J]. Aging Clin Exp Res, 2019, 31(12): 1791-1800.
18	阳婷婷, 唐轶洋, 张兴安. 舒芬太尼与瑞芬太尼复合丙泊酚全凭静脉麻醉用于神经外科手术效果与安全性的系统评价[J]. 中国循证医学杂志, 2013, 13(12): 1492-1499.
	Yang TT, Tang YY, Zhang XA. Efectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery: a systematic review[J]. Chin J Evid Based Med, 2013, 13(12): 1492-1499.
19	Muñoz-Leyva F, Cubillos J, Chin KJ. Managing rebound pain after regional anesthesia[J]. Korean J Anesthesiol, 2020, 73(5): 372-383.
20	Sunderland S, Yarnold CH, Head SJ, et al. Regional versus general anesthesia and the incidence of unplanned health care resource utilization for postope-rative pain after wrist fracture surgery: results from a retrospective quality improvement project[J]. Reg Anesth Pain Med, 2016, 41(1): 22-27.
21	Sort R, Brorson S, Gögenur I, et al. Rebound pain following peripheral nerve block anaesthesia in acute ankle fracture surgery: an exploratory pilot study[J]. Acta Anaesthesiol Scand, 2019, 63(3): 396-402.

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项目	对照组	浸润组	阻滞组	P值
麻醉分级（Ⅱ）	31	30	31	1.000
性别（男/女）	18/13	20/10	21/10	0.685
年龄/月	15.5±16.7	12.2±13.2	16.6±18.4	0.642
手术方式（唇/腭）	15/16	14/16	15/16	0.988
舒芬太尼/（μg·kg^-1）	0.36±0.77	0.34±0.12	0.32±0.73	0.295
七氟烷/（mL·kg^-1）	4.40±2.05	4.18±1.48	4.65±1.79	0.590

测量项目		0 h	0.5 h	1 h	1.5 h	2 h	2.5 h	3 h	3.5 h	4 h	8 h	12 h	16 h	20 h	24 h
FLACC 评分	对照组	5.2±2.4	3.5±3.2	2.5±2.1	3.2±2.4	2.6±2.3	2.1±1.5	1.7±1.4	1.2±1.4	1.2±1.3	0.8±1.5	1.0±1.4	0.4±0.7	0.2±0.4	0.1±0.3
	浸润组	5.5±2.5	3.9±3.9	3.3±3.4	2.9±3.4	2.7±2.7	1.9±1.9	0.8±1.0	0.9±1.2	0.9±1.1	1.4±1.5	1.4±1.9	0.9±1.5	0.3±0.8	0.1±0.3
	阻滞组	5.4±2.7	3.5±2.1	3.2±2.2	2.5±1.9	1.6±1.7	1.4±1.6	1.2±1.6	1.2±1.6	1.4±1.9	0.8±1.3	1.1±1.9	0.9±1.4	0.3±0.7	0.1±0.3
	P值	0.607	0.777	0.569	0.467	0.272	0.213	0.021*	0.601	0.595	0.082	0.462	0.212	0.866	0.998
中重度疼痛人数	对照组	28	16	13	14	9	4	3	2	2	2	2	0	0	0
	浸润组	25	15	11	11	9	8	0	0	0	3	4	2	1	0
	阻滞组	23	15	12	9	4	4	3	4	6	2	4	4	0	0
	P值	0.248	0.969	0.914	0.425	0.213	0.268	0.215	0.128	0.025*	0.836	0.627	0.123	0.356	1

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