Objective: To evaluate the efficacy of ultrasound guidance for fascia iliaca compartment block in pediatric femoral surgery. Methods: This study was a prospective study, thirty children who were American Society of Anesthesiologists (ASA) statusⅠ with 5-10 years old scheduled for femoral surgery were selected in orthopedics department in Second Affiliated Hospital of Wenzhou Medical University from May to December in 2014. After induction of general anesthesia, all the children were inserted the laryngeal mask. Then they were received fascia iliaca compartment block using ultrasound guidance under sevoflurane inhalation anesthesia. The indicators including heart rate(HR), mean arterial pressure(MAP), oxygen saturation(SpO(2)) and exhaled sevoflurane concentration were recorded before skin incision(T(1)), at 1, 5, 10 min after incision(T(2)-T(4))and at the end of the surgery(T(5)). Postoperative pain were assessed using the pain behavior assessment scale at awake time, 2 h and 4 h after surgery. The efficacy of postoperative analgesia and the satisfaction of parents at 2 h and 4 h after surgery were recorded. Results: The differences between HR、MAP and SpO(2) in children at T(1)-T(5) were no statistical significance (all P>0.05). Exhaled sevoflurane concentration at T(1)-T(5) were(2.50±0.51)%, (2.51±0.42)%, (2.50±0.41)%, (2.54±0.31)% and(0.61±0.20)%, respectively, the differences were statistically significant(F=13.503, P<0.05), among them that at T(5) was significantly lower than at T(1)-T(4)(all P<0.05). The pain score at awake time, 2 h and 4 h after surgery were (1.6±0.7), (3.3±1.4) and (3.9±1.3) scores, respectively. The parents satisfaction were 87% and 73% at 2 h and 4 h afer surgery respectively. Conclusion: The way of ultrasound guidance for fascia iliaca compartment block combined with general anesthesia can be safely and effectively used in pediatric femoral surgery. Using the technique of ultrasonic imaging, the fascia iliaca compartment can be directly observed and then the local anesthetics is injected, therefore the efficacy of block is improved.
目的： 评价超声引导下髂筋膜间隙阻滞在小儿股骨手术中的应用效果。 方法： 本研究为前瞻性研究，选择2014年5至12月温州医科大学附属第二医院骨科行股骨手术的患儿30例，美国麻醉医师协会(ASA)Ⅰ级，年龄5～10岁。全麻诱导后所有患儿置入喉罩，并在七氟烷吸入麻醉下行超声引导髂筋膜间隙阻滞。记录患儿切皮前(T(1))、切皮后1 min(T(2))、5 min(T(3))、10 min (T(4))和手术结束时(T(5))的心率、平均动脉压、脉氧饱和度及七氟烷呼出浓度等指标，采用疼痛行为评估量表对患儿苏醒时、术后2 h及4 h行疼痛评估，记录患儿的术后镇痛效果、术后2 h及4 h患儿家长的满意情况。 结果： 患儿在T(1) ～T(5)各时点心率、平均动脉压、脉氧饱和度比较差异均无统计学意义(均P>0.05)，T(1) ～T(5)各时点七氟烷呼气末浓度分别为(2.50±0.51)%、(2.51±0.42)%、(2.50±0.41)%、(2.54±0.31)%及(0.61±0.20)%，差异有统计学意义(F＝13.503，P<0.05)，其中T(5)时点七氟烷呼气末浓度明显低于T(1)～T(4)时点(均P<0.05)。苏醒时、术后2 h及4 h镇痛评分分别为(1.6±0.7)分、(3.3±1.4)分和(3.9±1.3)分。术后2 h及4 h的家长满意率分别为87%及73%。 结论： 超声引导髂筋膜间隙阻滞联合全身麻醉的方法可安全有效地应用于小儿股骨部位手术，利用超声成像技术可直接观察到髂筋膜间隙并把局麻药注入，因而提高阻滞效果。.
Keywords: Anesthesia; Child; Fascia; Femur; Nerve block; Ultrasonography.