地塞米松复合罗哌卡因臂丛神经阻滞对儿童肱骨髁上骨折患儿术后镇痛的影响

摘要 目的：探讨地塞米松复合罗哌卡因臂丛神经阻滞（BPB）对儿童肱骨髁上骨折患儿术后镇痛效果的影响。方法：择期行肱骨髁上骨折手术的患儿140例，随机分组为对照组70例与试验组70例。麻醉后两组均于超声引导下实施BPB，其中对照组予以0.25%罗哌卡因药液，试验组予以0.25%罗哌卡因、0.1 mg/kg地塞米松所组成的混合药液。记录两组患儿痛觉阻滞时间；于患儿苏醒后10 min、术后2 h、术后6 h、术后12 h及术后24 h，采用FLACC评分对患儿疼痛程度进行评估；记录两组患儿术后24 h内镇痛药物使用情况；记录两组患儿术后首次下床活动时间和术后住院时间；记录两组术后24 h内不良反应发生情况。结果：与对照组相比，试验组痛觉阻滞时间显著延长（P<0.05）。与对照组相比，试验组术后2~24 h的疼痛评分均显著降低（P<0.05）。试验组术后24 h布洛芬混悬液使用次数显著少于对照组（P<0.05），曲马多使用率显著低于对照组（P<0.05）。与对照组相比，试验组下床活动时间提前（P<0.05），术后住院时间缩短（P<0.05）。两组不良反应发生率无统计学差异（P>0.05）。结论：地塞米松复合罗哌卡因行BPB能够为肱骨髁上骨折患儿提供良好术后镇痛效果，利于患儿术后恢复。

Effect of Dexamethasone Combined with Ropivacaine Brachial Plexus Block on Postoperative Analgesia in Children with Supracondylar Fracture of Humerus

ABSTRACT Objective: To investigate the effect of dexamethasone combined with ropivacaine brachial plexus block (BPB) on postoperative analgesia in children with supracondylar fracture of humerus. Methods: 140 children with supracondylar fracture of humerus were randomly divided into control group (70 cases) and experimental group (70 cases). After anesthesia, BPB was performed under ultrasound guidance in both groups. The control group was given 0.25 % ropivacaine solution, and the experimental group was given a mixture of 0.25 % ropivacaine and 0.1 mg/kg dexamethasone. The pain block time of the two groups was recorded. FLACC score was used to evaluate the degree of pain at 10 min after recovery, 2 h, 6 h, 12 h and 24 h after operation. The use of analgesic drugs within 24 hours after operation was recorded in the two groups. The first time to get out of bed and postoperative hospital stay were recorded in the two groups. The adverse reactions of the two groups within 24 hours after operation were recorded. Results: Compared with the control group, the pain block time of the experimental group was significantly prolonged (P<0.05). Compared with the control group, the pain scores of the experimental group were significantly lower at 2-24 hours after operation (P<0.05). The use of ibuprofen suspension in the experimental group was significantly less than that in the control group (P<0.05), and the use of tramadol was significantly lower than that in the control group (P<0.05). Compared with the control group, the time of getting out of bed in the experimental group was earlier (P<0.05), and the postoperative hospital stay was shorter (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Dexamethasone combined with ropivacaine for BPB can provide good postoperative analgesic effect for children with supracondylar fracture of humerus, which is conducive to postoperative recovery.