Comparison of Inguinal Nerve Block and Intravenous Fentanyl in Relieving Postinguinal Herniorrhaphy Pain for Pediatric Outpatients

腹股溝神經阻斷與靜脈給予Fentanyl對小兒門診腹股溝疝氣術後疼痛控制的比較

陳豐熙(Feng-Shi Chen) ； 黃潔文(Teresa K.M. Wong) ； 石明煌(Ming-Hwang Shyr) ； 陳克章(Hut-Cheung Chan) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 29卷2期 (1991/06) Pp. 580-585

摘要

The purpose of this study was to compare the effects of ilioinguinal/iliohypogastric (lG/IH) nerve block and intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric outpatients. Seventy-five ASA physical status I and II children (aged 1 to 10 yr) with unilateral inguinal herniorrhaphy under general anesthesia were randomly divided into three groups. Group A received IG/IH nerve block, using 0.25% bupivacaine (1 mg/kg) immediately after induction. Group B received intravenous fentanyl (1 μg/kg) immediately after induction. Group C received only general anesthesia as control. At postanesthetic care unit (PACU), we recorded the degree of pain/or discomfort at 5, 15, 30, 45 and 60 min using modified Hannallah's scoring system after the patient was fully awake. The degree of recovery was also evaluated using Steward's scoring system. After discharge, the parents were interrogated about the condition of child within 24 h by telephone. Follow-up items raised included vomiting, drowsiness, pain and shivering. Our results showed that children in both study groups had lower pain score than those in the control group, and in the fentanyl group children had lower pain score than in the nerve block group during the first 30 min at PACU. The recovery time was also longer in the fentanyl group. There was no significant difference among the three groups regarding the raised items over telephone interrogation. In sum, inguinal nerve block was effective for postoperative pain relief in children undergoing inguinal herniorraphy. We also suggested that small dose of intravenous fentanyl would serve as an easy, simple and effective means for relieving postinguinal herniorrhaphy pain during the first 30 min of the initial postoperative period.

關鍵字

Ilioinguinal/Iliohypogastric nerve block ； Intravenous fentanyl ； Pediatric outpatients

並列摘要

本研究以75位接受單側腹股溝疝氣手術的小兒門診病人為研究樣本，分成3組，每組各為25人。A組於麻醉誘導後，立即給予0.25% bupivacaine（1mg／kg）作ilioinguinal／iliohypogastric（IG／IH）神經阻斷。B組於麻醉誘導後，立即給予靜脈注射fentanyl（1μg／kg）。C組為對照組，只接受全身麻醉。手術後待病人清醒後，送至恢復室，在恢復室時，分別利用modified Hannallah's及Steward's評分系統對病人疼痛及恢復情形做評估。並於出院後24小時內，以電話追踪病人的恢復及疼痛情形。結果顯示在恢復室觀察的前30分鐘，A，B二組病人比C組具較低的疼痛分數，並且B組需花較長的時間才能達Steward's滿分（6分）的程度。而電話追踪方面顯示，A，B，C三組病人在疼痛及恢復情形均無明顯的差別。因此，我們認為除了IG／IH神經阻斷能提供良好的小兒腹股溝疝氣術後疼痛控制外，靜脈給予小劑量的fentanyl，對手術後初期前30分鐘的疼痛控制亦是一種簡單又有效的方法。