ABSTRACT
Objective To evaluate the anesthetic effect and safety of ropivacaine combined with lidocaine caudal block in the treatment of pediatric laparoscopic hernia surgery.Methods A total of 70 cases with pediatric hernia surgery in Ningbo Women and Children’s Hospital from May 2014 to October 2015 in this study were divided into control group and experimental group with 35 cases in each group.The patients in the both groups were given routine examination, preoperative anesthesia induction, adopted 7 scalp injection needles to prick into the hiatus sacralis,patients in control group were treated by 1% lidocaine hydrochloride injection mixed liquid 1 mL/kg;patients in the experimental group were treated by 0.25%lidocaine hydrochloride injection and 0.25% ropivacaine hydrochloric injection mixed liquid 1 mL/kg; pediatric hernia surgery, intraoperative continuous pumped into propofol injection 4-6 mL/kg and maintain the mask to the oxygen.The visual analog pain scored( VAS) , visual satisfaction scored ( VSS) and adverse reactions were compared at the end of operation, after operation 0 h,0.5 h,1 h,2 h,4 h,8 h and 24 h.Results The sensory and motor block effective time in the experimental group were later than the control group, the sensory and motor block duration time were shorter than the control group (P<0.05).VAS score of the experimental group was significant lower than control group after operation 2 h ( P<0.05 ) . After operation, postoperative 0.5 h, postoperative 1 h, the VSS score of the experimental group was significant lower than control group ( P<0.05 ) .Lower limbs numbness discomfort duration time of the experimental group was significant lower than control group after operation ( P<0.05 ) . Postoperative agitation rate of the experimental group 8.57% was significant lower than the control group 34.29% (P<0.05).The incidence of adverse reactions of experimental group 5.71% was significant lower than the control group 25.71% ( P<0.05 ) .Conclusion Ropivacaine combined with lidocaine caudal block in the treatment of pediatric hernia surgery has the remarkable effect, with high safety.
ABSTRACT
Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty.Methods 80 children (aged 2 -6,weight 10 -25kg,ASAⅠ -Ⅱ)with high ligation of hernia sac were divided into two groups according to the random number table method:group S -sevoflurane combined with inguinal region block under laryngeal airway ventilation;group K -ketamine combined with caudal block.Group S was inhalated with 6% -8% sevoflurane for foundation anesthesia,and then followed with vein induction:fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interop-eration.Group K was adopted the intramuscular ketamine (5mg/kg)for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move,choking cough,etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0 ),1min after skin cutting (T1 ),5min after skin cutting (T2 ),the end of operation (T3 )and awaken time (T4 ).The body movement was observed intraoperation,the number of SpO2≤95% and awaken restlessness,the recovery time and residence time in anesthesia recovery room were recorded.Results The values of MAP in group S at time points of T1 ,T2 ,T3 were (77.6 ±6.2)mmHg,(77.8 ±6.4)mmHg,(76.5 ±4.7)mmHg respectively,and the values of MAP in group K at time points of T1 ,T2 ,T3 were (86.9 ±8.1)mmHg,(88.1 ±5.3)mmHg,(86.4 ±6.5)mmHg respectively.The t values at time points of T1 ,T2 ,T3 were 5.766,7.893,7.806 respectively when the group S compared with group K(P <0.0001),the group S was superior to group K.The values of HR in group S at time points of T1 ,T2 ,T3 were (121.3 ± 9.6)times/min,(121.9 ±8.4)times/min,(120.3 ±7.8)times/min respectively,and the values of HR in group K at time points of T1 ,T2 ,T3 were (138.6 ±9.4)times/min,(136.5 ±7.5)times/min,(128.7 ±6.9)times/min respec-tively.The t values at time points of T1 ,T2 ,T3 were 8.144,8.200,5.101 respectively(P <0.0001),the group S was superior to group K.The MAP and HR were more smoothly in group S than in group K.The recovery time in group S and K was (7.5 ±3.4)min and (16.7 ±5.5)min respectively(t =8.99,P <0.0001),it was shorter in group S than in group K.The residence time in anesthesia recovery room was (15.4 ±4.2)min and (23.7 ±6.3)min respectively (t =6.93,P <0.0001),it was shorter in group S than in group K.Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2 =10.32,P <0.001);Cases of SpO2 ≤95% was 4 and 12 respec-tively in group S and group K(χ2 =10.32,P <0.001),the occurrence of body movements and SpO2 ≤95% cases was lower in group S than in group K.Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction,faster recovery,the hemodynamics was more stable,adverse reactions was fewer and so on,it can be safely used in pediatric anesthesia.