Application of bilateral rectus sheath block guided by ultrasound in laparoscopic high ligation of hernia sac in children

doi:10.3877/cma.j.issn.1674-0785.2020.02.003

Abstract

Abstract:

Objective

To observe the effect of bilateral rectus sheath block (BRSB) guided by ultrasound in laparoscopic high ligation of hernia sac in children.

Methods

Fifty-six patients who underwent laparoscopic high ligation of hernial sac in children at Yancheng Maternity and Child Health Care Hospital from January to July 2018 were randomly divided into either a bilateral rectus abdominis sheath block group (group B) or a routine anesthesia group (group C), with 28 cases in each group. Heart rate and mean arterial pressure (MAP) were recorded at three time points, namely, prior to incision (T₁), at incision (T₂), and at laparoscopic lens fixation (T₃). Time to removal of laryngeal mask, post-anesthesia care unit (PACU) stay, restlessness after operation, and total amount of fentanyl used in anesthesia were also recorded.

Results

MAP and heart rate at T₂ in group C were significantly higher than those at T₁ and T₃ (F=23.76, P<0.001; F=21.53, P<0.001), while MAP and heart rate at T₂ in group B were not significantly different from those at T₁ and T₃ (F= 0.41, P=0.53; F=2.14, P=0.06); MAP and heart rate at T₂ in group B were significantly lower than those in group C (t=10.72, P<0.001; t=7.83, P<0.001). There was no significant difference between the two groups in time to removal of laryngeal mask or duration of stay in PACU (P>0.05). The pain score, the incidence of agitation, and total amount of fentanyl in group C were significantly higher than those in group B (P>0.05) .

Conclusion

Bilateral rectus block guided by ultrasound can reduce the fluctuation of blood pressure and heart rate, decrease the dosage of fentanyl used, and improve the quality of recovery during the operation of laparoscopic high ligation of hernia sac in children.

Key words: Rectus sheath block, Child, Ultrasonography, Hemodynamics, Fentanyl

Xinmin Zhao, Yuanyuan Chen, Fang Fang, Zhengliang Song, Gedong Ming. Application of bilateral rectus sheath block guided by ultrasound in laparoscopic high ligation of hernia sac in children[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(02): 90-93.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2020.02.003

https://zhlcyszz.cma-cmc.com.cn/EN/Y2020/V14/I02/90

Figures/Tables 6

References 16

[1]	Maldonado JR, Wysong A, Van Der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery [J]. Psychosomatics, 2009, 50(3): 206-217.
[2]	王新星，李帅，汤绍涛, 等. 单纯经脐腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝 [J]. 临床小儿外科杂志, 2016, 4(15): 348-350.
[3]	Uchinami Y, Sakuraya F, Tanaka N, et al. Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children [J]. Paediatr Anaesth, 2017, 27(5): 516-523.
[4]	Flack SH, Martin LD, Walker BJ, et al. Ultrasound-guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorpt ion [J]. Paediatr Anaesth, 2014, 24(9): 968-973.
[5]	Nagata J, Watanabe J, Nagata M, et al. Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach [J]. Asian J Endosc Surg, 2017, 10(3): 336-338.
[6]	熊虹飞，李思远，刘鸿涛, 等. 超声引导下腹横肌平面阻滞在新生儿下腹部手术中的应用 [J]. 临床麻醉学杂志, 2018, 34(8): 785-787.
[7]	Litz CN, Farach SM, Fernandez AM, et al. Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial [J]. J Pediatr Surg, 2017, 52(6): 901-906.
[8]	Maloney C, Kallis M, El-Shafy IA, et al. Ultrasound-guided bilateral rectus sheath block vs. conventional local analgesia in single port laparoscopic appendectomy for children with nonperforated appendicitis [J]. J Pediatr Surg, 2018, 53(3): 431-436.
[9]	赵新民，方芳，岳书玉, 等. 右美托咪定在小儿腹腔镜疝囊高位结扎手术麻醉中的应用 [J]. 临床小儿外科杂志, 2017, 16(5): 487-490.
[10]	陈龙兰，杨斌，魏淑萍, 等. 儿童超声引导下经皮肾活检术后并发症的原因分析 [J]. 医学研究生学报, 2014, 27(7): 706-709.
[11]	Hamill JK, Rahiri JL, Liley A, et al. Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials [J]. Paediatr Anaesth, 2016, 26(4): 363-371.
[12]	Bashandy GM, Elkholy AH. Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision [J]. Anesth Pain Med, 2014, 4(3): e18263.
[13]	Cho S, Kim YJ, Jeong K, et al. Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study [J]. J Anesth, 2018, 32(2): 189-197.
[14]	Relland LM, Tobias JD, Martin D, et al. Ultrasound-guided rectus sheath block, caudal analgesia, or surgical site infiltration for pediatric umbilical herniorrhaphy: a prospective, double-blinded, randomized comparison of three regional anesthetic techniques [J]. J Pain Res, 2017, 9(10): 2629-2634.
[15]	Ammar A, Mahmoud K, Kasemy Z. Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled tria [J]. Acta Anaesthesiol Scand, 2018, 62(6): 857-862.
[16]	Song ZL, Yue SY, Chen YY, et al. Comparison of Oro-Pharyngeal airway cap and tracheal intubation on systemic stress responses and hemodynamic parameters in pediatric laparoscopic procedures [J]. Int J Clin Exp Med, 2017, 10(5): 7973-7980.

项目	0分	1分	2分
脸	微笑或无特殊表情	偶尔出现痛苦表情，皱眉，不愿交流	经常或持续出现下颚颤抖或紧咬下颚
腿	放松或保持平常姿势	不安，紧张，维持于不舒服的姿势	踢腿或腿部拖动
活动度	安静躺着，正常体位或轻松活动	扭动，翻来覆去，紧张	痉挛，身体成弓形，僵硬
哭闹	不哭（清醒或睡眠中）	呻吟，啜泣，偶尔诉痛	一直哭泣，尖叫，经常诉痛
可安慰性	满足，放松	偶尔抚摸拥抱和言语可以被安慰	难以被安慰

项目	0分	1分	2分
脸	微笑或无特殊表情	偶尔出现痛苦表情，皱眉，不愿交流	经常或持续出现下颚颤抖或紧咬下颚
腿	放松或保持平常姿势	不安，紧张，维持于不舒服的姿势	踢腿或腿部拖动
活动度	安静躺着，正常体位或轻松活动	扭动，翻来覆去，紧张	痉挛，身体成弓形，僵硬
哭闹	不哭（清醒或睡眠中）	呻吟，啜泣，偶尔诉痛	一直哭泣，尖叫，经常诉痛
可安慰性	满足，放松	偶尔抚摸拥抱和言语可以被安慰	难以被安慰

组别	例数	男/女（例）	年龄（岁）	体质量（kg）	手术时间（min）
腹直肌鞘阻滞组	28	2/26	3.7±1.2	13.8±1.8	20.4±2.1
常规麻醉组	28	3/25	3.7±1.3	13.8±1.9	20.3±2.3
统计值	?	χ²=0.23	t=0.13	t=0.50	t=1.06
P值	?	0.89	0.90	0.75	0.81

组别	例数	男/女（例）	年龄（岁）	体质量（kg）	手术时间（min）
腹直肌鞘阻滞组	28	2/26	3.7±1.2	13.8±1.8	20.4±2.1
常规麻醉组	28	3/25	3.7±1.3	13.8±1.9	20.3±2.3
统计值	?	χ²=0.23	t=0.13	t=0.50	t=1.06
P值	?	0.89	0.90	0.75	0.81

组别	例数	T₁	T₂	T₃	F值	P值
腹直肌鞘阻滞组	28	67.2±6.0	67.8±5.9	67.8±5.7	0.41	0.53
常规麻醉组	28	69.1±7.3^a	86.3±5.7	71.1±6.1^a	23.76	<0.001
t值	?	0.90	10.72	1.90	?	?
P值	?	0.34	<0.001	0.06	?	?

Please choose a citation manager

Content to export