探讨髂腹股沟/髂腹下神经阻滞在小儿日间手术中的应用效果。

选取2011年11月至2012年4月拟于本院日间手术室择期行腹股沟斜疝、鞘膜积液手术等的60例患儿为研究对象。按照麻醉方式，将其按照入院顺序号随机分为：Le组(左布比卡因组，n＝20)，Li组(利多卡因组，n＝20)与对照组(n＝20)。对3组患儿均常规进行基础麻醉，静脉注射盐酸戊乙奎醚(长托宁)0.01 mg/kg＋丙泊酚2 mg/kg＋氯胺酮2 mg/kg。Le组与Li组在台式彩色多普勒超声诊断仪引导下，分别采用0.25%左布比卡因(0.5 mL/kg)与2%利多卡因(0.5 mL/kg)进行髂腹股沟/髂腹下神经阻滞。对照组在手术消毒时，再静脉注射丙泊酚2 mg/kg＋氯胺酮1 mg/kg。记录3组患儿镇痛不足再次静脉注射氯胺酮的次数和剂量与患儿苏醒时间。记录3组患儿诱导前(T0)、诱导后(T1)、切皮时(T2)、牵拉疝囊时(T3)、缝皮时(T4)的心率(HR)、呼吸频率(RR)、血氧饱和度(SpO₂)、平均动脉压(MAP)及术中及术后不良反应，如尿潴留，瘙痒、恶心呕吐等发生率，并采用FLACC疼痛行为评分量表对术后2 h，4 h以及6 h进行疼痛评分(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书)。

①3组患儿年龄、体重、性别、疾病种类、手术时间等一般临床资料比较，差异均无统计学意义(P>0.05)。②Li组和Le组T2，T3时点的MAP，HR，RR与对照组比较，差异有统计学意义(P<0.05)。对照组患儿在T2，T3时点的MAP，HR，RR与T0时点组内比较，差异有统计学意义(P<0.05)。③对照组患儿术中再次静脉注射氯胺酮剂量和次数，明显多于Li组与Le组，对照组复苏时间也明显延长，差异均有统计学意义(P<0.05)；而Le组再次静脉注射氯胺酮次数和剂量，显著少于Li组，差异有统计学意义(P<0.05)。④Li组与Le组术后表现出良好镇痛效果，FLACC疼痛行为评分显著低于对照组(P<0.05)，Le组在术后6 h时FLACC疼痛行为评分显著低于Li组(P<0.05)；Li组和Le组术后恶心、呕吐发生率显著低于对照组，差异有统计学意义(P<0.05)；而尿潴留及瘙痒发生率3组比较，则差异均无统计学意义(P>0.05)。

髂腹股沟/髂腹下神经阻滞可提供良好的术中麻醉效果及术后镇痛作用，且术后并发症发生率低，恢复快，适用于小儿日间手术麻醉。

To evaluate the efficacy of ilioinguinal or iliohypogastric nerve block in pediatric ambulatory surgery.

From November 2011 To April 2012, a total of 60 pediatric patients, who were scheduled for elective inguinal hernia or hydrocele, were enrolled into the study. According to the methods of anesthesia, they were randomly allocated using a computer-generated sequence of numbers to one of the three groups: Group Le (group levobupivacaine, n=20), group Li (group lidocaine, n=20), control group(n=20). In all three groups, penehyclidine hydrochloride(0.01 mg/kg), ketamine(2 mg/kg) and propofol(2 mg/kg) were given to perform basis anesthesia. Children in groups Le and Li received an ilioinguinal or iliohypogastric block under ultrasonic diagnosis with 0.25% levobupivacaine and 2% lidocaine at 0.5 mL/kg, respectively. Children in control group just received ketamine(1 mg/kg) and propofol (2 mg/kg) anesthesia during surgical sterilization. During surgery, dosages and times of additional ketamine and postoperative recovery time were recorded. The vital signs of heart rate(HR), respiratory rate(RR), pulse oxygen saturation (SpO₂), mean arterial pressure(MAP) were recorded in five time points during surgery: the basal(T0), anesthesia induction(T1), the skin incision(T2), pulling hernial sac(T3), seaming the skin(T4). And intra-or postoperation adverse events of urine retention, pruritus, postoperative nausea and vomiting(PONV) were also recorded. Face legs activity cry consolability(FLACC) score was used to assess the pain score postoperatively at 2 h, 4 h, 6 h postoperation respectively.(This clinical trial was reviewed and approved by the Ethiscs Committee of the hospital. For each pediatric patient , written informed consent was obtained from his or her parents of legal guardians).

① The demographic data of age, weight, gender, the kinds of surgery, and surgery time were no significantly difference(P>0.05). ②MAP, HR, and RR at T2 and T3 in group Li and Le were significantly higher than those in control group(P<0.05). MAP, HR, and RR at T2 and T3 were significantly difference than those at T0 in control group(P<0.05). ③The dosages and times of additional ketamine in control group were significantly more than those in group Li and Le(P<0.05), and the dosages and times of additional ketamine in group Li were significantly more than those in group Le(P<0.05). The recovery time in control group were significantly longer than those in group Li and Le(P<0.05). ④The FLACC pain scores at 2 h, 4 h, 6 h postoperation in control group were significantly higher than those in group Li and Le(P<0.05), the FLACC pain scores at 6 h postoperation in group Li was significantly than those in group Le(P<0.05). The incidences of PONV in groups Le and Li were significantly lower than those in control group(P<0.05), and there was no significantly differences in incidences of urine retention and pruritus among the three groups(P>0.05).

With good anesthesia/postoperative analgesia and less complications, ilioinguinal or iliohypogastric nerve block in pediatric ambulatory surgery is both feasible and effective.