摘要：
Objective To investigate the analgesic efficacy of ultrasound guided transversus abdominis plane block and to compare the efficacy of posterior approach and medial approach of ultrasound guided transversus abdominis plane block (TAPB) in providing postoperative analgesia after children laparoscopic groin surgery.Methods Eligible children 2 ～ 4 years old (n =60),American society of anesthesiologists (ASA) I,undergoing elective laparoscopic unilateral groin surgery were randomly assigned into posterior approach group (Group P),medial approach group (Group M) and control group (Group C).Many parameters were measured and recorded during the study,including funk sedation scores,intraoperative circulation monitoring at time points of T1 (before induction),T2 (skin incision) and T3 (skin closure),length of surgery,the time from post anesthesia care unit (PACU) arrival to the first obtainable pain score,length of PACU stay,modified-children's hospital of eastern ontario pain scale(m-CHEOPS),pediatric anesthesia emergence delirium (PAED) scores,number of children with sufentanil administered in PACU,number of people occurred nausea and vomiting,and satisfaction of parents.Results There were no statistically significant difference in general characteristics,basic emotion score,duration of surgery,the time from PACU arrival to first obtainable score,haemodynamic parameter at T1 and satisfaction of parents among groups P,M,and C.However,the m-CHEOPS scores at the time points of first obtainable,10 min,the number of children received sufentanil administration,PAED scores and haemodynamic parameter at T2 and T3 were significantly lower in groups P and M than in group C.There were no significant difference in parameters mentioned above between groups P and M.Conclusions Ultrasound guided transversus abdominis plane block could provide efficient and secure postoperative analgesia for children undergoing laparoscopic groin surgery.Both posterior approach and medial approach are ideal options.%目的 观察超声引导下腹横肌平面阻滞用于小儿腹腔镜腹股沟区手术术后镇痛效果,比较不同入路时超声引导下腹横肌平面阻滞的镇痛效果差异.方法 择期行腹腔镜单侧腹股沟区手术的患儿60例,年龄2～4岁,ASA分级Ⅰ级,按随机数余数法分成后路组、内路组、对照组(每组20例).后路组与内路组患儿于全麻下行超声引导下不同入路的腹横肌平面阻滞.分别观察并记录患儿的入室基础情绪,入室、切皮、缝皮时的心率、血压,手术时间,苏醒时间,麻醉后恢复室(PACU)留观时间,改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS),苏醒期躁动评分(PAED),PACU给药例数,术后恶心呕吐例数及家长满意度.结果 三组患儿在一般情况、基础情绪、手术时间、苏醒时间、入室的心率、血压、家长满意度等方面差异无统计学意义(P＞0.05).后路组与内路组患儿在m-CHEOPS首次评分及之后20 min内评分、躁动发生率、PACU给药例数及切皮、缝皮时的心率、血压均低于对照组(P＜0.05).上述观察指标在后路组与内路组患儿之间差异无统计学意义(P＞0.05).结论 超声引导下腹横肌平面阻滞能够为小儿腹腔镜腹股沟区手术提供良好术后镇痛,减少静脉镇痛药的应用,后路法与内路法是腹横肌平面阻滞较佳入路.
