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

摘要：

目的　分析改良骶管麻醉复合腰方肌阻滞在小儿髋关节脱位手术中的应用效果及对术后躁动及应激反应影响。方法　前瞻性选取2022年3月至2025年3月西安交通大学附属红会医院收治的120例髋关节脱位手术患儿，应用随机数字表法分为骶管麻醉组、腰方肌阻滞组、联合组，每组40例。骶管麻醉组中男23例、女17例，年龄（2.23±0.54）岁，美国麻醉医师协会（ASA）分级：Ⅰ级21例、Ⅱ级19例。腰方肌阻滞组中男21例、女19例，年龄（2.30±0.25）岁，ASA分级：Ⅰ级25例、Ⅱ级15例。联合组中男24例、女16例，年龄（2.35±0.41）岁，ASA分级：Ⅰ级24例、Ⅱ级16例。所有患儿均采取七氟烷吸入全麻，全麻诱导后，骶管麻醉组、腰方肌阻滞组、联合组分别实施改良骶管麻醉、腰方肌阻滞、改良骶管麻醉复合腰方肌阻滞。比较3组麻醉优良率，术后2、6、12 h的疼痛程度［视觉模拟评分法（VAS）评分］，术后5、10、20 min患儿躁动情况［小儿麻醉苏醒期谵妄量表（PAED）评分］，手术前及术后1、3 d去甲肾上腺素（NE）、皮质醇（COR）水平。采用χ²、F检验进行统计分析。结果　骶管麻醉组、腰方肌阻滞组、联合组麻醉优良率分别为90.0%（36/40）、85.0%（34/40）、100.0%（40/40），联合组高于骶管麻醉组、腰方肌阻滞组（均P<0.05）；骶管麻醉组与腰方肌阻滞组差异无统计学意义（P>0.05）。3组患儿VAS评分术后6 h均升高，术后12 h均降低。联合组术后2、6、12 h的VAS评分［（4.11±1.25、5.45±1.24、3.24±0.82）分］均低于骶管麻醉组［（5.45±1.24、6.20±1.27、4.28±0.95）分］、腰方肌阻滞组［（5.21±1.22、6.34±2.01、5.02±1.11）分］（均P<0.05），术后12 h骶管麻醉组的VAS评分低于腰方肌阻滞组（P<0.05）。3组患儿术后10、20 min的PAED评分均降低。术后5、10、20 min联合组的PAED评分［（5.25±0.88、4.45±0.36、2.22±0.23）分］均低于骶管麻醉组［（7.11±1.94、5.60±0.92、3.31±0.36）分］、腰方肌阻滞组［（7.61±1.33、5.83±0.70、3.35±0.47）分］，差异均有统计学意义（均P<0.05）；骶管麻醉组与腰方肌阻滞组差异均无统计学意义（均P>0.05）。3组患儿的NE、皮质醇水平术后1 d均升高，术后3 d均降低。术后1、3 d的NE和皮质醇水平，联合组分别为（243.34±41.46、223.56±36.83）ng/L和（60.26±9.32、51.46±6.36）µg/L，骶管麻醉组分别为（281.93±38.78、252.53±36.54）ng/L和（67.62±5.44、58.83±7.54）µg/L，腰方肌阻滞组分别为（315.84±37.67、274.53±31.54）ng/L和（85.43±7.68、65.52±9.52）µg/L，联合组均低于骶管麻醉组、腰方肌阻滞组，骶管麻醉组均低于腰方肌阻滞组，差异均有统计学意义（均P<0.05）。结论　改良骶管麻醉复合腰方肌阻滞应用于小儿髋关节脱位手术，可提高麻醉优良率，减轻患儿术后疼痛和躁动情况，降低术后应激反应。

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