局部浸润治疗肱骨髁上骨折闭合复位经皮克氏针固定术后疼痛的效果  

Effect of local infiltration therapy on postoperative pain of supracondylar humeral fracture after closed reduction and percutaneous Kirschner wire fixation

作　　者：王勇[1] 刘万林[1] 韦宜山[1] 白锐[1] 李岱鹤[1] 赵振群[1] 孙超[1] 孙亮[1] 吉利[1] 张丽华[1] Wang Yong;Liu Wanlin;Wei Yishan;Bai Rui;Li Daihe;Zhao Zhenqun;Sun Chao;Sun Liang;Ji Li;Zhang Lihua(Department of Pediatric Orthopaedic,Second Affiliated Hospital,Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学第二附属医院小儿骨科,呼和浩特010030

出　　处：《中华小儿外科杂志》2022年第4期359-364,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的评估GartlandⅢ型儿童肱骨髁上骨折闭合复位经皮克氏针固定术后采用0.25%左旋布比卡因局部浸润治疗术后疼痛的效果。方法将2018年6月至2020年5月在内蒙古医科大学第二附属医院就诊的183例GartlandⅢ型肱骨髁上骨折患儿作为研究对象。术前排除37例可能影响术后疼痛测量的患儿,排除2例手术时间>1 h的患儿,最终144例患儿纳入本研究,应用随机数字表法将所有患儿分为0.25%左旋布比卡因组(72例)和对照组(72例)。左旋布比卡因组中,男39例,女33例;年龄为(71.67±11.33)个月,体重为(22.76±5.07)kg;受伤侧别左侧38例,右侧34例;从受伤到入院间隔时间为(6.54±5.55)h。对照组中,男45例,女27例;年龄为(73.29±11.46)个月,体重为(23.19±4.76)kg;患侧侧别左侧46例,右侧26例;从受伤到入院间隔时间为(5.83±4.78)h。记录术后口服非甾体抗炎药的剂量和给药时间,评估两组患儿术后疼痛的严重程度。结果所有患儿手术均顺利完成,无骨筋膜室综合征、医源性神经损伤、局部麻醉药全身反应等并发症。3例发生浅表感染,其中对照组1例,左旋布比卡因组2例;144例患儿均无深部感染发生。①在术后疼痛评分方面,术后第一天对照组有48.6%(35/72)发生重度疼痛(CRIES疼痛评分>7分),且全部发生在术后≤8 h,重度疼痛患儿中术后4 h发生的占45.7%(16/35),术后6 h发生的占40.0%(14/35),术后8 h发生的占14.3%(5/35)。术后第一天左旋布比卡因组仅有2.8%(2/72)发生重度疼痛,1例发生在术后6 h,1例为术后8 h。术后第一天重度疼痛的发生率在两组之间的差异具体统计学意义(P<0.05)。②在术后服用布洛芬方面,第一天对照组有76.4%(55/72)口服了布洛芬,首次服药时间在术后2 h的占7.3%(4/55),术后4 h和6 h各占36.4%(20/55),术后8 h占16.4%(9/55),术后12 h占3.6%(2/55),55例患儿中术后第一天有6例服药2次。左旋布比卡因组有33.3%(24/72)口服了布洛芬,首次服药Objective To evaluate the effect of 0.25%levobupivacaine local infiltration for postoperative pain after closed reduction and percutaneous Kirschner wire fixation of Gartland typeⅢsupracondylar humeral fractures in children.Methods From June 2018 to May 2020,clinical data were reviewed for 183 children with Gartland type III supracondylar humeral fractures.Preoperatively 37 children potentially affecting postoperative pain measurement and 2 children with operative duration>1 h were excluded.And 144 children were divided randomly into two groups of 0.25%levobupivacaine(n=72)and control(n=72).There were 39 boys and 33 girls with an age range of(71.67±11.33)months and a weight range of(22.76±5.07)kg.The involved side was left(n=38)and right(n=34).The interval from injury to admission was(6.54±5.55)hours.In control group,there were 45 boys and 27 girls with an age range of(73.29±11.46)months and a weight range of(23.19±4.76)kg.The involved side was left(n=46)and right(n=26).The interval from injury to admission was(5.83±4.78)hours.The dose and administration time of postoperative oral non-steroidal anti-inflammatory drugs were recorded for assessing the severity of postoperative pain in two groups.Results All operations were completed successfully and none had such complications as compartment syndrome,iatrogenic nerve injury or systemic reaction to local anesthetics.Superficial infection occurred in 3 cases,including control group(n=1)and levobupivacaine group(n=2).There was no deep infection.In terms of postoperative pain score,48.6%(35/72)in control group had severe pain(CRIES pain score>7 points)at Day 1 postoperatively and at≤8 h postoperatively.Among children with severe pain,45.7%(16/35)occurred at 4 h,40.0%(14/35)at 6 h and 14.3%(5/35)at 8 h post-operation.In levobupivacaine group,only 2.8%(2/72)developed severe pain at Day 1 postoperatively,6 h(n=1)and 8 h(n=1)postoperatively.The inter-group difference in the incidence rate of severe pain at Day 1 postoperatively had statistical significance(P<0.05

关 键 词：肱骨骨折 术后镇痛 局部浸润 左旋布比卡因 

分 类 号：R726.8[医药卫生—儿科]