舌咽神经阻滞对儿童扁桃体切除术后疼痛的影响

Effect of glossopharyngeal nerve block with bupivacaine on pain after tonsillectomy in childrenK

摘要:

目的探讨布比卡因舌咽神经阻滞对儿童扁桃体切除术后疼痛的影响。方法采用前瞻性随机对照研究方法，收集92例行扁桃体手术切除的患儿，随机分为布比卡因舌咽神经阻滞组（治疗组）和未接受布比卡因舌咽神经阻滞组（对照组）各46例，其中，治疗组在手术结束后立即行布比卡因双侧舌咽神经阻滞，对照组手术结束后不给予任何处理，比较两组术后首次请求镇痛的时间、使用对乙酰氨基酚镇痛平均剂量，术后休息和吞咽时对患儿面部表情（face）、腿的姿势(legs)、躯体活动度(activity)、哭闹(crying)、是否安慰(consolability)5项进行疼痛评分（FLACC），术后咽反射情况、吞咽困难程度，以及术后并发症发生率和父母满意度。结果治疗组术后首次请求对乙酰氨基酚镇痛的时间较对照组明显延长（P<0.01），使用对乙酰氨基酚的平均剂量明显低于对照组（P<0.05）；治疗组在术后6 h休息和吞咽时FLACC评分较对照组明显降低（P<0.01）；治疗组对咽反射的反应和吞咽困难程度较对照组明显降低（P＜0.01）；而术后并发症的发生率没有增加（P>0.05），父母的满意度较对照组有明显提高（P＜0.01）。结论布比卡因双侧舌咽神经阻滞可有效地减轻儿童扁桃体切除术后早期疼痛，改善患儿术后生理舒适度及生活质量，提高父母满意度，而无明显麻醉不良反应。

关键词:舌咽神经|扁桃体切除术|镇痛|咽反射|吞咽

Abstract:

ObjectiveTo explore the effect of glossopharyngeal nerve block with bupivacaine on pain after tonsillectomy in children.MethodsUsing a method of prospective randomized controlled study, 92 children undergoing tonsillectomy were collected, which were randomly divided into glossopharyngeal nerve block with bupivacaine group (treatment group) and nonglossopharyngeal nerve block group (control group), and 46 cases in each group. Bilateral glossopharyngeal nerve block with bupivacaine was performed immediately after tonsillectomy in the treatment group, while no treatment was given in the control group. The time of the first postoperative analgesia request and the average dose of acetaminophen for analgesia postoperative were compared between the two groups.The postoperative pain was assessed during rest and swallowing using the FLACC (face, legs, activity, cry, consolability) tool. The postoperative response to gag reflex, degree of difficulty in swallowing, the incidence of postoperative complications and parents’ satisfaction were compared between the two groups.ResultsThe duration of first postoperative acetaminophen analgesia was significantly longer in the treatment group than that in the control group (P<0.01).The average dose of acetaminophen in the treatment group was significantly lower than that in the control group (P<0.05). The FLACC score of the treatment group was significantly lower than that of the control group at 6 h during rest and swallowing (P<0.01). The elimination of the pharyngeal reflex and the difficulty swallowing in the treatment group were significantly lower than those in the control group (P<0.01). However, the incidence of postoperative complications was not significantly increased in the treatment group than that in the control group(P>0.05). The satisfaction of parents in the treatment group was significantly higher than that in the control group (P<0.01).ConclusionBilateral glossopharyngeal nerve block with bupivacaine can effectively reduce early postoperative pain and improve the physical comfort and quality of life in children after tonsillectomy, as well as improve their parental satisfaction.The treatment had no obvious adverse effects of anesthesia.

Key words:Glossopharyngeal Nerve|Tonsillectomy|Analgesia|Pharyngeal reflex; Swallowing