Comparison of effects of two analgesia methods on surgery for developmental dysplasia of the hip in children

Bing  Peng; Xifeng  Zhang; Li  Gu; Wenxu Jiang

doi:10.2298/VSP231113026P

Bing Peng Nanjing Pukou People’s Hospital, Jiangsu Province, Nanjing, China
Xifeng Zhang Children’s Hospital of Nanjing Medical University, Department of Anesthesiology, Jiangsu Province, Nanjing, China
Li Gu Children’s Hospital of Nanjing Medical University, Department of Anesthesiology, Jiangsu Province, Nanjing, China
Wenxu Jiang Children’s Hospital of Nanjing Medical University, Department of Anesthesiology, Jiangsu Province, Nanjing, China

DOI: https://doi.org/10.2298/VSP231113026P

Ključne reči: analgezija;, anestezija, kaudalna;, anestezija, epiduralna;, deca;, kuk, razvojna displazija;, hirurgija, operativne procedure

Sažetak

Uvod/Cilj. Za hirurško lečenje razvojne displazije kuka (RDK) često je potrebna acetabuloplastika i femoralna osteotomija. Ovu vrstu operacije karakteriše dugo trajanje, velika trauma i jak postoperativni bol. Cilj rada bio je da se uporede analgetski efekti kaudalne blokade (KB) i epiduralne blokade (EB) u hirurškom lečenju RDK kod dece. Metode. Ukupno je odabrano 100 dece, koja su bila podvrgnuta hirurškom lečenju RDK u našoj bolnici od maja 2018. do decembra 2021. godine, i nasumično podeljeno u dve grupe: grupu sa ultrazvučno vođenom KB i grupu sa EB (svaka grupa se sastojala od po 50 dece). Zabeležene su doze ropivakaina, promene krvnog pritiska, brzine otkucaja srca i intraoperativna doza fentanila. Osim toga, zabeležene su vrednosti još nekoliko parametara nakon operacije: procenjivan je skor modifikovane skale lica, nogu, aktivnosti, plača i utehe (Face, Legs, Activity, Cry, and Consolability – FLACC) 2, 4, 6, 12, 24, 36 i 48 sati nakon operacije; vreme prvog zahteva za acetaminofenom i procenat bolesnika koji su koristili petidin; stepen sedacije u toku 12 sati nakon operacije (procenjen korišćenjem Ramsay-eve skale sedacije – RSS); stopa učestalosti pojave mučnine, povraćanja i zadržavanja urina; stepen zadovoljstva članova porodice primenjenim metodama postoperativne analgezije kod dece. Rezultati. Doza ropivakaina koja je korišćena u grupi KB bila je veća od doze korišćene u grupi EB (p < 0,05). Grupa KB je imala niži FLACC skor 12 i 24 sata nakon operacije i duže postoperativno vreme do trenutka prvog zahteva za acetaminofenom u odnosu na grupu EB (p < 0,05). Nisu se pojavile nikave komplikacije povezane sa blokadama; obe grupe su imale slične stope učestalosti mučnine, povraćanja i zadržavanja urina. RSS skor tokom 12 sati nakon operacije bio je viši u grupi KB nego u grupi EB, a članovi porodice dece iz grupe KB bili su zadovoljniji (p < 0,05). Zaključak. I KB i EB mogu pružiti zadovoljavajuću intraoperativnu i postoperativnu analgeziju u pedijatrijskoj hirurgiji kuka. Međutim, KB pruža efikasnu analgeziju 24 sata nakon operacije i traje duže od one koju postiže EB.

Reference

Zhou Y, Li R, Li C, Zhou P, Li Y, Ke YH, et al. Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0-6 months. BMC Pediatr 2020; 20(1): 280.

Ashoor M, Abdulla N, Elgabaly EA, Aldlyami E, Alshryda S. Evidence based treatment for developmental dysplasia of the hip in children under 6 months of age. Systematic review and exploratory analysis. Surgeon 2021; 19(2): 77–86.

Volk T, Kubulus C. Regional anesthesia - are the standards changing? Anaesthesist 2017; 66(12): 904–9. (German)

Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Clin Anesth 2020; 59: 106–11.

Yang H, Fan W, Yang Y, Zhou J, Zhang H, Sun J, et al. Application of dexmedetomidine combined with ropivacaine in axillary brachial plexus block in children and its effect on inflammatory factors. Cell Mol Biol (Noisy-le-grand) 2020; 66(5): 73–9.

Wang X, Xu S, Qin X, Li X, Feng SW, Liu Y, et al. Comparison Between the Use of Ropivacaine Alone and Ropivacaine With Sufentanil in Epidural Labor Analgesia. Medicine (Baltimore) 2015; 94(43): e1882.

Lönnqvist PA, Ecoffey C, Bosenberg A, Suresh S, Ivani G. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us? Curr Opin Anaesthesiol 2017; 30(5): 613–20.

Rove KO, Brockel MA, Saltzman AF, Dönmez MI, Brodie KE, Chalmers DJ, et al. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. J Pediatr Urol 2018; 14(3): 252.e1–9.

McEvoy MD, Scott MJ, Gordon DB, Grant SA, Thacker JKM, Wu CL, et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU. Perioper Med (Lond) 2017; 6: 8.

Trifa M, Tumin D, Tobias JD. Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children. Minerva Anestesiol 2018; 84(7): 836–47.

Vargas A, Sawardekar A, Suresh S. Updates on pediatric regional anesthesia safety data. Curr Opin Anaesthesiol 2019; 32(5): 649–52.

Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Can J Anaesth 2013; 60(9): 840–54.

Boric K, Dosenovic S, Jelicic Kadic A, Batinic M, Cavar M, Urlic M, et al. Interventions for postoperative pain in children: An overview of systematic reviews. Paediatr Anaesth 2017; 27(9): 893–904.

Poređenje efekata dve metode analgezije u hirurškom lečenju razvojne displazije kuka kod dece

Sažetak

Reference