关键词:

髋关节脱位, 改良骶管麻醉, 腰方肌阻滞, 躁动, 应激反应, 小儿

Abstract:

Objective　To analyze the application effect of improved sacral anesthesia combined with lumbar muscle block on pediatric hip dislocation surgery and its impact on postoperative agitation and stress response. Methods　A total of 120 children undergoing hip dislocation surgery at Xi'an Jiaotong University Affiliated Honghui Hospital from March 2022 to March 2025 were prospectively selected and randomly assigned to three groups: the sacral anesthesia group, the lumbar muscle block group, and the combined group, with 40 cases in each group. In the sacral anesthesia group, there were 23 males and 17 females, with an average age of (2.23±0.54) years; American Society of Anesthesiologists (ASA) classification: 21 cases of grade I and 19 cases of grade II. In the lumbar muscle block group, there were 21 males and 19 females, with an average age of (2.30±0.25) years; ASA classification: 25 cases of grade I and 15 cases of grade II. In the combined group, there were 24 males and 16 females, with an average age of (2.35±0.41) years; ASA classification: 24 cases of grade I and 16 cases of grade II. All children received sevoflurane inhalation for general anesthesia. After induction, the sacral anesthesia group, lumbar muscle block group, and combined group underwent improved sacral anesthesia, lumbar muscle block, and improved sacral anesthesia combined with lumbar muscle block, respectively. The anesthesia efficacy rates were compared among the three groups, and pain levels were evaluated at 2, 6, and 12 hours postoperative using the Visual Analogue Scale (VAS). The agitation of children was assessed at 5, 10, and 20 minutes postoperative using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Cortisol and norepinephrine (NE) levels were measured before surgery and at 1 and 3 days postoperative. Statistical analysis was performed using χ² and F tests. Results　The anesthesia efficacy rates were 90.00% (36/40) for the sacral anesthesia group, 85.00% (34/40) for the lumbar muscle block group, and 100.00% (40/40) for the combined group, with the combined group being significantly higher than both the sacral anesthesia group and the lumbar muscle block group (both P<0.05). There was no statistically significant difference between the sacral anesthesia group and the lumbar muscle block group (P>0.05). VAS scores increased at 6 hours postoperative in all three groups and decreased at 12 hours postoperative. The VAS scores at 2, 6, and 12 hours postoperative in the combined group [(4.11±1.25, 5.45±1.24, 3.24±0.82) points] were all lower than those in the sacral anesthesia group [(5.45±1.24, 6.20±1.27, 4.28±0.95) points] and the lumbar muscle block group [(5.21±1.22, 6.34±2.01, 5.02±1.11) points] (P<0.05). At 12 hours postoperative, the VAS score in the sacral anesthesia group was lower than that in the lumbar muscle block group (P<0.05). The PAED scores at 10 and 20 minutes postoperative decreased in all three groups; at 5, 10, and 20 minutes postoperative, the combined group [(5.25±0.88, 4.45±0.36, 2.22±0.23) points] had lower scores than the sacral anesthesia group [(7.11±1.94, 5.60±0.92, 3.31±0.36) points] and the lumbar muscle block group [(7.61±1.33, 5.83±0.70, 3.35±0.47) points], with all differences being statistically significant (all P<0.05); there was no significant difference between the sacral anesthesia group and the lumbar muscle block group (P>0.05). The levels of NE and cortisol in the three groups increased at 1 day after operation and decreased at 3 days after operation. The NE and cortisol levels at 1 and 3 days postoperative in the combined group were (243.34±41.46, 223.56±36.83) ng/L and (60.26±9.32, 51.46±6.36) µg/L, respectively; in the sacral anesthesia group, they were (281.93±38.78, 252.53±36.54) ng/L and (67.62±5.44, 58.83±7.54) µg/L, respectively; and in the lumbar muscle block group, they were (315.84±37.67, 274.53±31.54) ng/L and (85.43±7.68, 65.52±9.52) µg/L, respectively. The combined group values were lower than those in both the sacral anesthesia group and the lumbar muscle block group, and the sacral anesthesia group values were lower than those in the lumbar muscle block group, with all differences being statistically significant (all P<0.05). Conclusion　The application of modified sacral anesthesia combined with quadratus lumborum block in pediatric hip dislocation surgery can improve the excellent and good rate of anesthesia, reduce postoperative pain and agitation, and reduce postoperative stress response.

Key words:

Hip dislocation, Improved sacral anesthesia, Lumbar muscle block, Restlessness, Stress response, Children