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目的:观察布比卡因局部阻滞在小儿扁桃体、腺样体切除术后镇痛效果。方法:选择ASAⅠ-Ⅱ级患儿60例,随机分为布比卡因局部阻滞组(A组)、曲马朵静脉麻醉组(B组)和对照组(C组)各20例。A组给予0.2%布比卡因,行双侧扁桃体窝及腭舌弓上、中、下3点浸润;B组于手术结束前5min给予曲马朵2mg/kg缓慢静脉注射;C组给予生理盐水5～7ml,行双侧扁桃体窝及腭舌弓上、中、下3点浸润。比较3组术后Wong-Baker表情评分及CHEOPS评分,并观察和比较各组术后并发症及追加镇痛情况。结果:术后5、15、30、60、120min,A组和B组的CHEOPS评分及Wong-Baker表情评分均显著低于C组(P<0.05),A组与B组间两项评分差异不显著(P>0.05);术后240、360min,A组CHEOPS评分及Wong-Baker表情评分均显著低于B组和C组(P<0.05)。C组术后需追加镇痛百分率显著高于A组和B组(P<0.05)。结论:小儿扁桃体切除术后镇痛可减轻患儿痛苦;布比卡因局部阻滞镇痛和静脉曲马朵镇痛均能达到良好的镇痛效果,但局部阻滞镇痛时间较曲马朵静脉镇痛延长。
Objective: To observe the analgesic effect of bupivacaine local blockade in pediatric tonsil and adenoid resection. Methods: Sixty children with ASA Ⅰ-Ⅱ were randomly divided into two groups: the bupivacaine group (group A), the tramadol group (group B) and the control group (group C). In group A, 0.2% bupivacaine was infused into the bilateral tonsil fossa and the palatal tongue at the upper, middle and lower 3 points. Group B received intravenous tramadol 2 mg / kg 5 min before the end of surgery. Group C received physiological Saline 5 ~ 7ml, line bilateral tonsil fossa and palatal tongue bow, middle and lower infiltration 3:00. The postoperative Wong-Baker facial expression scores and CHEOPS scores of the three groups were compared. Postoperative complications and additional analgesia were observed and compared. Results: At 5, 15, 30, 60 and 120 minutes after operation, the scores of CHEOPS and Wong-Baker in group A and group B were significantly lower than those in group C (P <0.05). There was no significant difference between group A and group B (P> 0.05). At 240 and 360 minutes after operation, CHEOPS score and Wong-Baker expression score in group A were significantly lower than those in group B and C (P <0.05). Postoperative analgesia was significantly higher in group C than in groups A and B (P <0.05). Conclusion: Analgesia in pediatric tonsillectomy can reduce the pain in children. Local anesthesia with bupivacaine and analgesia with intravenous tramadol can achieve good analgesic effect. Pain in the veins prolonged.