Postoperative analgesia effect of levobupivacaine combined with dexmedetomidine in infraorbital nerve block for cleft lip repair in children

doi:10.3877/cma.j.issn.1673-5250.2017.01.009

Objective

To investigate the postoperative analgesic effect of levobupivacaine combined with dexmedetomidine applied to infraorbital nerve block for cleft lip repair in children.

Methods

A total of 60 children who were diagnosed as congenital cleft lip and underwent cleft lip repair surgery in Guangzhou Women and Children′s Medical Center from April to July 2016 were selected as study objects. According to the random number table, the 60 patients were divided into 3 groups, LD group (received levobupivacaine and dexmedetomidine for infraorbital nerve block), L group (received levobupivacaine for infraorbital nerve block), and control group (received normal saline solution for infraorbital nerve block), 20 cases for each group. FLACC scale values were used to evaluate the postoperative pain. The FLACC scores at 0.5, 1, 2, 4, 8, 12 h after cleft lip repair, the analgesics drug requirements and adverse reactions were compared among 3 groups statistically. This study has been approved by the ethics committee of Guangzhou Women and Children′s Medical Center and all the parents of participants signed the informed consents.

Results

①There were no significant differences among 3 groups of congenital cleft lip children in age, gender constituent ratio, body weight and durations of surgery (P>0.05). ②The FLACC scores of 0.5 and 1 h after operation in LD group were lower than those of L group and control group, respectively, the FLACC scores of 0.5 and 1 h after operation in L group were lower than those of control group, and all the differences above were statistically significant (P<0.05). There were no significant differences among 3 groups in FLACC scores of 2, 4, 8 and 12 h after operation (P>0.05). ③ Effective analgesia time in LD and L group were longer than that of control group, respectively, effective analgesia time in LD group was longer than that of L group, and all the differences were statistically significant (P<0.05). Acetaminophen use rates and total dose of sufentanil in LD and L group were lower or less than those of control group, respectively, acetaminophen use rates and total dose of sufentanil in LD group were lower or less than those of L group, and all the differences were statistically significant (P<0.05). ④ There were no significant differences among 3 groups in adverse reaction rate (χ²=3.25, P=0.420).

Conclusion

Levobupivacaine combined with dexmedetomidine for infraorbital nerve block analgesia is safe and effective for children after cleft lip repair.

Key words: Levobupivacaine, Dexmedetomidine, Nerve block, Cleft lip, Analgesia, Child

表1 3组先天性唇裂患儿一般临床资料比较

组别	例数	年龄(月,±s)	性别[例数(%)]		体重(kg, ±s)	手术时间(min, ±s)
组别	例数	年龄(月,±s)	男	女	体重(kg, ±s)	手术时间(min, ±s)
LD组	20	12.3±6.2	11(55.0)	9(45.0)	10.5±3.9	61.6±12.7
L组	20	16.2±7.5	12(60.0)	8(40.0)	10.7±3.5	57.9±13.5
对照组	20	15.5±6.3	13(65.0)	7(35.0)	11.0±4.2	65.4±14.3
检验值	?	F＝0.51	χ²＝1.56		F＝0.85	F＝1.43
P值	?	0.780	0.370		0.520	0.220

表1 3组先天性唇裂患儿一般临床资料比较

组别	例数	年龄(月,±s)	性别[例数(%)]		体重(kg, ±s)	手术时间(min, ±s)
组别	例数	年龄(月,±s)	男	女	体重(kg, ±s)	手术时间(min, ±s)
LD组	20	12.3±6.2	11(55.0)	9(45.0)	10.5±3.9	61.6±12.7
L组	20	16.2±7.5	12(60.0)	8(40.0)	10.7±3.5	57.9±13.5
对照组	20	15.5±6.3	13(65.0)	7(35.0)	11.0±4.2	65.4±14.3
检验值	?	F＝0.51	χ²＝1.56		F＝0.85	F＝1.43
P值	?	0.780	0.370		0.520	0.220

表2 3组先天性唇裂患儿术后不同时间点FLACC疼痛评分比较(分,±s)

组别	例数	0.5 h	1 h	2 h	4 h	8 h	12 h
LD组	20	1.8±0.3	2.2±0.2	2.8±0.5	3.3±0.2	3.4±0.4	4.5±0.6
L组	20	2.4±0.4	2.6±0.3	3.1±0.4	3.5±0.6	3.7±0.7	4.8±0.6
对照组	20	3.0±0.5	3.1±0.4	4.3±0.5	4.8±0.8	5.2±1.0	6.4±0.9
F值	?	146.50	32.60	0.65	0.52	0.45	0.72
P值	?	0.007	0.009	0.120	0.260	0.380	0.290

表2 3组先天性唇裂患儿术后不同时间点FLACC疼痛评分比较(分,±s)

组别	例数	0.5 h	1 h	2 h	4 h	8 h	12 h
LD组	20	1.8±0.3	2.2±0.2	2.8±0.5	3.3±0.2	3.4±0.4	4.5±0.6
L组	20	2.4±0.4	2.6±0.3	3.1±0.4	3.5±0.6	3.7±0.7	4.8±0.6
对照组	20	3.0±0.5	3.1±0.4	4.3±0.5	4.8±0.8	5.2±1.0	6.4±0.9
F值	?	146.50	32.60	0.65	0.52	0.45	0.72
P值	?	0.007	0.009	0.120	0.260	0.380	0.290

表3 3组先天性唇裂患儿有效镇痛时间及镇痛药物使用情况比较

组别	例数	有效镇痛时间(min, ±s)	对乙酰氨基酚使用率[例数(%)]	舒芬太尼使用总量(μg, ±s)
LD组	20	297±21	11(55.0)	6.5±7.8
L组	20	246±63	13(65.0)	12.5±9.4
对照组	20	141±72	15(75.0)	18.2±6.5
检验值	?	F＝14.82	χ²＝19.81	F＝18.54
P值	?	0.007	0.031	0.003

表3 3组先天性唇裂患儿有效镇痛时间及镇痛药物使用情况比较

组别	例数	有效镇痛时间(min, ±s)	对乙酰氨基酚使用率[例数(%)]	舒芬太尼使用总量(μg, ±s)
LD组	20	297±21	11(55.0)	6.5±7.8
L组	20	246±63	13(65.0)	12.5±9.4
对照组	20	141±72	15(75.0)	18.2±6.5
检验值	?	F＝14.82	χ²＝19.81	F＝18.54
P值	?	0.007	0.031	0.003

[1]	Nicodemus HF, Ferrer MJ, Cristobal VC, et al. Bilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children[J]. Scand J Plast Reconstr Surg Hand Surg, 1991, 25(3): 253-257.
[2]	Grewal G, Garg K, Grewal A. Bilateral infraorbital nerve block versus intravenous pentazocine: a comparative study on post-operative pain relief following cleft lip surgery[J]. J Clin Diagn Res, 2015, 9(5): UC04-UC06.
[3]	Jindal P, Khurana G, Dvivedi S, et al. Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery[J]. Saudi J Anaesth, 2011, 5(3): 289-294.
[4]	Feriani G, Hatanaka E, Torloni MR, et al. Infraorbital nerve block for postoperative pain following cleft lip repair in children[J]. Cochrane Database Syst Rev, 2016, 4: CD011131.
[5]	Wang H, Liu G, Fu W, et al. The effect of infraorbital nerve block on emergence agitation in children undergoing cleft lip surgery under general anesthesia with sevoflurane[J]. Paediatr Anaesth, 2015, 25(9)：906-910.
[6]	Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioral scale for scoring postoperative pain in young children[J]. Pediatr Nurs, 1997, 23(3): 293-297.
[7]	Ramsay MA, Savege TM, Simpson BR, et al. Controlled sedation with alphaxalone-alphadolone[J]. Br Med J, 1974, 22(2): 656-659.
[8]	Takmaz SA, Uysal HY, Uysal A, et al. Bilateral extraoral, infraorbital nerve block for postoperative pain relief after cleft lip repair in pediatric patients: a randomized, double-blind controlled study[J]. Ann Plast Surg, 2009, 63(1): 59-62.
[9]	Jonnavithula N, Durga P, Kulkarni DK, et al. Bilateral intra-oral, infra-orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine-pethidine combination[J]. Anaesthesia, 2007, 62(6): 581-585.
[10]	Mariano ER, Watson D, Loland VJ, et al. Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery[J]. Can J Anaesth, 2009, 56(8)：584-589.
[11]	Prabhu KP, Wig J, Grewal S. Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip[J]. Scand J Plast Reconstr Surg Hand Surg, 1999, 33(1): 83-87.
[12]	Sathyanarayana LA, Heggeri VM, Simha PP, et al. Comparison of epidural bupivacaine, levobupivacaine and dexmedetomidine in patients undergoing vascular surgery[J]. J Clin Diagn Res, 2016, 10(1): UC13-UC17.
[13]	Öz Gergin Ö, Yildiz K, Bayram A, et al. Comparison of the myotoxic effects of levobupivacaine, bupivacaine, and ropivacaine: an electron microscopic study[J]. Ultrastruct Pathol, 2015, 39(3): 169-176.
[14]	Goyal A, Shankaranarayan P, Ganapathi P. A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections[J]. Anesth Essays Res, 2015, 9(1): 57-62.
[15]	Demiraran Y, Ozturk O, Guclu E, et al. Vasoconstriction and analgesic efficacy of locally infiltrated levobupivacaine for nasal surgery[J]. Anesth Analg, 2008, 106(3): 1008-1011.
[16]	Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations[J]. Br J Anaesth, 2015, 115(2): 171-182.
[17]	唐桂萍,王向兵,刘炜,等. 右美托咪定联合臂丛神经阻滞在上肢骨折手术的应用[J]. 临床麻醉学杂志,2012, 28(9): 854-856.
[18]	Suresh S, Wheeler M. Practical pediatric regional anesthesia[J]. Anesthesiol Clin North America, 2002, 20(1): 83-113.

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