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Objective:To investigate the effects of ultrasound-guided bilateral erector spinal plane nerve block on postoperative pain and sleep quality in children with pectus excavatum undergoing Nuss.Methods:From February 2020 to December 2021, 40 children with pectus excavatum undergoing Nuss from Hunan Children′s Hospital were prospectively selected and randomly divided into two groups: group E (group E) with erector spinal muscle plane block combined with general anesthesia and group G (group G) , with 20 patients in each group. After general anesthesia, ultrasound guided plane nerve block of bilateral erector spinal muscles was performed in group E, and general anesthesia with tracheal intubation was performed in group G. The Visual Analogue Scale (VAS) Score were recorded at 2, 6, 12, 24 and 48 hours after surgery; The addition of sufentanil, the time of extubation of post anesthesia recovery room (PACU) and the time of leaving the PACU in each group were recorded; The effective pressure times of analgesic pump and the number of people for remedial analgesia were recorded. Pittsburgh sleep quality index (PSQI) was used to score the sleep quality of children before and 2 days after surgery. The occurrence of hypoxemia and restlessness after extubation, nausea and vomiting, pneumothorax, local anesthetic poisoning and other complications were recorded.Results:The VAS score of group E at 2, 6, 12 and 24 hours after operation was lower than that of group G (all P<0.05). There was no significant difference in VAS score 48 hours after operation between the two groups ( P>0.05). The time of decannulation and recovery of PACU in group E was shorter than that in group G (all P<0.05). Compared with group G, there were fewer cases of sufentanil added in group E during operation, and the number of analgesia pump pressing times and cases of postoperative remedial analgesia in group E were less than those in group G (all P<0.05). The PSQI score of sleep quality index 2 days after operation in group E was better than that in group G ( P<0.05). The incidence of hypoxemia, restlessness, nausea and vomiting in group E was lower than that in group G (all P<0.05). Conclusions:Ultrasound-guided bilateral erector spinal nerve block can effectively reduce postoperative pain and complications of NUSS in children with pectus excavatum, and can also reduce the amount of sufentanil used during the operation, improve the sleep quality after the operation, which is conducive to the recovery of children, and is worthy of promotion.
RESUMO
Objective To observe the effect of sodium acetate Ringer solution on serum levels of electrolytes, blood glucose (Glu) and lactic acid (Lac) in peri-operational stage of children undergoing neurosurgery. Methods Forty cases of children prepared to undergo neurosurgery admitted into Hunan Children's Hospital from December 2018 to April 2019 were enrolled, and according to the criteria of American Society of Anesthesiologists (ASA), they were classified into Ⅰ-Ⅱ grade. They were divided into a sodium acetate Ringer solution group and a sodium lactate Ringer solution group by random number table method, 20 cases in each group. Sodium acetate Ringer solution group was given the sodium acetate Ringer solution; sodium lactate Ringer solution group was given the sodium lactate Ringer solution, and both groups used intravenous infusion of their own respective solution at a rate of 10 mL·kg-1·h-1. Arterial blood gas detections were measured after anesthesia induction (T1), 1 hour after administration (T2), 2 hours after administration (T3) and at the end of surgery (T4); the changes in serum levels of electrolyte concentrations, blood Glu and Lac were observed in the patients of two groups. Results With the prolonged operation time, the levels of Glu and Lac in the two groups showed an increasing trend, compared with the levels at T1 and T2 , the levels were increased at T3 and T4 [the sodium lactate ringer solution group: Glu (mmol/L) were 5.85±1.02, 6.95±1.21 vs. 5.28±0.72, 5.20±0.62, and Lac (mmol/L) were 1.53±0.74, 1.91±1.41 vs. 1.23±0.71, 1.38±0.69; sodium acetate ringer solution group: Glu (mmol/L) was 5.44±0.86, 5.85±1.12 vs. 5.05±0.85, 5.14±0.74, Lac (mmol/L) were 1.58±1.31, 1.61±1.23 vs. 1.14±0.65, 1.28±0.95, all P < 0.05], the Lac and Glu levels at T4 in sodium acetate Ringer solution group were significantly lower than those in sodium lactate Ringer solution group (both P < 0.05). There were no statistically significant differences in pH value, Na+, K+ and residual base (BE) levels between the two groups at different time points (all P > 0.05). Conclusion Sodium acetate Ringer solution used in pediatric neurosurgery for more than 2 hours can reduce the blood lactic acid level without rising blood glucoselevel. Therefore, it is more suitable for infusion during pediatric neurosurgery.