Analgesic effect of continuous infusion of low-dose dexmedetomidine combined with scalp nerve block after craniotomy in preschool children
10.3760/cma.j.cn131073.20240227.00912
- VernacularTitle:静脉输注小剂量右美托咪定联合头皮神经阻滞用于学龄前儿童开颅术后镇痛的效果
- Author:
Ling LI
1
;
Yaxin WANG
;
Xu JIN
Author Information
1. 首都医科大学附属北京天坛医院麻醉科，北京 100070
- Keywords:
Dexmedetomidine;
Nerve block;
Scalp;
Child, preschool;
Neurosurgical procedures;
Analgesia
- From:
Chinese Journal of Anesthesiology
2024;44(9):1106-1111
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the analgesic effect of continuous infusion of low-dose dexmedetomidine combined with scalp nerve block after craniotomy in preschool children.Methods:This single-center, prospective, double-blind, randomized controlled study included 120 pediatric patients, aged 3-7 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, with body mass index of 12-25 kg/m 2, who underwent elective craniotomy at Beijing Tiantan Hospital from May 2022 to December 2023. The patients were divided into 2 groups ( n=60 each) using a random number table method: IV infusion of low-dose dexmedetomidine combined with scalp nerve block group (Dex+ SNB group) and scalp nerve block group (SNB group). Dexmedetomidine 0.2 μg·kg -1·h -1 (in 50 ml of normal saline) was intravenously infused over 24 h in Dex+ SNB group, while the equal volume of normal saline was given instead in SNB group. The electronic intravenous analgesia pump was routinely used after operation, the solution contained sufentanil 2 μg/kg + ondansetron 0.3 mg/kg in 100 ml of normal saline, and the pump was set up to deliver a 2 ml bolus dose with a 30-min lockout interval and no background infusion. The FLACC scale was used to evaluate the level of pain. The FLACC scale was used to evaluate the degree of pain. When the FLACC pain scale score ≥ 4, the analgesia pump was first pressed by the nursing staff in the post-anesthesia care unit, intensive care unit or ward. If that did not work, oral acetaminophen was given at a dose of 15 mg/kg for rescue analgesia. The consumption of sufentanil was recorded within 1, 2, 4, 18, 24 and 48 h after operation. The FLACC score, Richmond agitation-sedation score (RASS score) and Cornell pediatric delirium score (CAPD score) were assessed at 1, 2, 4, 18, 24 and 48 h after operation. The occurrence of moderate or severe pain (pain FLACC score≥4), rescue analgesia, excessive sedation (RASS score≤-3), agitation (RASS score≥2), delirium (CAPD score > 9) and poor sleep quality (sleep quality score≤2) within 48 h after operation were recorded. The occurrence of drug- and surgery-related adverse reactions within 48 h after operation was recorded. Results:Fifty-six children were ultimately included in SNB group, and 55 children in Dex + SNB group. Compared with SNB group, the consumption of sufentanil was significantly reduced within 2, 4, 18 and 24 h postoperatively, the FLACC score for pain was decreased at 18 h postoperatively, the incidence of poor sleep quality was decreased on postoperative day 1 ( P<0.05), and no significant change was found in the incidence of moderate or severe pain, excessive sedation, agitation, delirium and adverse reactions after surgery in Dex+ SNB group ( P>0.05). Conclusions:Compared with scalp nerve block alone, combination of IV infusion of low-dose dexmedetomidine and scalp nerve block can reduce the amount of opioids and improve sleep quality when used for postoperative analgesia in preschool children undergoing craniotomy.
