关键词:

先天性髋关节脱位, 罗哌卡因, 超声引导, 地塞米松, 髂前上棘, 髂筋膜间隙阻滞, 小儿

Abstract:

Objective　To investigate the effects of general anesthesia (GA) combined with ultrasound-guided dexamethasone and ropivacaine in fascia iliaca compartment block at the level of the anterior superior iliac spine during surgery for congenital dislocation of the hip (CDH) in children. Methods　This study is a randomized controlled trial. A prospective study was conducted involving 100 children undergoing CDH surgery at Xi'an People's Hospital (Fourth Hospital of Xi'an) from March 2023 to September 2024. The children were randomly divided into a control group and an observation group, with 50 cases in each. In the control group, there were 14 males and 36 females, with an average age of (4.20±1.03) years; American Society of Anesthesiologists (ASA) classification: 33 cases of grade I and 17 cases of grade II. In the observation group, there were 11 males and 39 females, with an average age of (4.36±1.12) years; ASA classification: 31 cases of grade I and 19 cases of grade II. Both groups received ultrasound-guided fascia iliaca compartment block at the level of the anterior superior iliac spine combined with general anesthesia, with the control group using ropivacaine and the observation group using a combination of dexamethasone and ropivacaine. Heart rate and mean arterial pressure (MAP) were compared between the two groups at five time points: before induction of general anesthesia (T₀), at tracheal intubation (T₁), at skin incision (T₂), 1 hour intraoperatively (T₃), and at extubation (T₄). Anesthesia recovery and maintenance parameters were assessed (recovery room stay duration, extubation time, and dosages of remifentanil and propofol). Serum inflammatory markers [interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)] were measured before induction and 6 hours postoperatively. The Face Pain Scale (FPS) scores were recorded preoperatively and at 6, 12, and 24 hours postoperatively, along with the incidence of adverse reactions. Statistical analysis was performed using repeated measures ANOVA, t tests, and χ² tests. Results　At time points T₁, T₂, T₃, and T₄, the MAP and heart rate in the observation group were significantly lower than those in the control group (all P<0.05). The recovery room stay duration and extubation time in the observation group were shorter than those in the control group [(18.65±5.42) min vs. (22.14±7.32) min; (9.25±2.81) min vs. (11.13±3.16) min], with statistically significant differences (t=2.709, 3.144, 2.827, 2.761; all P<0.05). The dosages of remifentanil and propofol in the observation group were lower than those in the control group [(186.49±42.21) µg vs. (211.36±45.69) µg; (192.71±44.51) mg vs. (218.36±48.32) mg], with all differences being statistically significant. Six hours postoperatively, serum levels of IL-6 and TNF-α in the observation group were lower than those in the control group [(16.76±3.73) ng/L vs. (19.42±4.38) ng/L; (37.28±8.34) ng/L vs. (42.79±8.93) ng/L]. The FPS scores at 6, 12, and 24 hours postoperatively were also lower in the observation group compared to the control group [(7.05±2.25, 5.16±1.62, 3.38±0.92) points vs. (8.34±2.62, 6.08±1.87, 4.04±1.11) points], with all differences being statistically significant (all P<0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (χ²=1.333, P=0.248). Conclusion　Ultrasound-guided fascia iliaca compartment block at the level of anterior superior iliac spine with dexamethasone and ropivacaine combined with general anesthesia can effectively relieve pain, stabilize intraoperative hemodynamics, reduce anesthetic dosage, shorten recovery time, reduce inflammatory reactions, and has good safety in CDH surgery.

Key words:

Congenital dislocation of hip, Ropivacaine, Ultrasound guidance, Dexamethasone, Anterior superior iliac spine, Fascia iliaca compartment block, Children