在接受开放式肛门成形术的儿童中使用腹横肌后方平面阻滞与腰方肌外侧阻滞：一项随机临床试验☆。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2024-09-01 DOI:10.1016/j.bjane.2023.06.004

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引用次数: 0

摘要

背景由于睾丸和精索的神经支配复杂，睾丸切除术中的镇痛管理可能具有挑战性。我们的目的是比较后侧腹横肌平面（TAP）和侧腰肌阻滞（QLB）对单侧睾丸吻合术中镇痛剂使用、疼痛和家长满意度的影响。手术前采用封闭包膜法将患者随机分为两组。两组患者均在超声波检查下使用 0.4 ml.kg-1 0.25% 布比卡因进行外侧 QLB 或后方 TAP 阻滞。主要结果是评估围手术期额外镇痛剂的使用情况。术后 24 小时前的疼痛评估和家长满意度也作为次要结果进行评估。需要使用瑞芬太尼的患者人数在 TAP 组明显较多（p < 0.001）。TAP组的平均FLACC评分（TAP：2.74 ± 1.8，QLB：0.7 ± 0.84）和Wong-Baker评分（TAP：3.13 ± 2.42，QLB：0.53 ± 1.12）明显更高（p < 0.001）。在第 10 分钟、第 20 分钟、第 6 小时、第 16 小时和第 24 小时，特别是在第 6 小时之后，TAP 的额外镇痛剂用量明显更高。在接受择期开放式单侧肛门直肠切除术的儿童中，QLB 组的家长满意度明显更高（p < 0.001）。

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Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆

Background

Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy.

Methods

ASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg⁻¹ 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes.

Results

A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10^th, 20^th minutes, 6^th, 16^th, and 24^th hours, especially after the 6^th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001).