PDF(Pubmed)
Abstract：
BACKGROUND: Surgery for lesions of the posterior fossa is associated with significant postoperative pain in pediatric patients related to extensive manipulation of the suboccipital musculature and bone. In this study, we assess the preliminary safety, effect on neuromonitoring, and analgesic efficacy of applying a cervical paraspinal interfascial plane block in pediatric patients undergoing posterior fossa surgery.
METHODS: In this prospective case series, we enrolled five patients aged 2-18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period.
RESULTS: No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up.
CONCLUSIONS: In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children.
METHODS: In this prospective case series, we enrolled five patients aged 2-18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period.
RESULTS: No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up.
CONCLUSIONS: In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children.
摘要：
背景：后颅窝病变的手术与小儿患者的严重术后疼痛有关，这与枕下肌肉组织和骨骼的广泛操作有关。在这项研究中,我们评估初步的安全性，对神经监测的影响，在接受后颅窝手术的小儿患者中应用颈椎旁筋膜间平面阻滞的镇痛效果。
方法：在本前瞻性病例系列中，我们纳入了5例2~18岁因有症状的ChiariI型畸形接受手术的患者.在切口之前进行超声引导的宫颈平面（CCeP）阻滞。在计划的枕下减压和C1椎板切除术的水平上，将局部麻醉剂（布比卡因）和类固醇佐剂（地塞米松）注射到颈半腰肌和颈半腰肌之间的筋膜平面。在阻滞前后监测运动诱发电位和体感诱发电位。评估患者术中局部注射的并发症和术后疼痛。
结果：术中没有发现不良事件，神经监测信号没有变化。术后即刻疼痛评分较低，救援药物很少。在术后3个月随访时，没有发现切口疼痛或需要麻醉剂的抱怨。
结论：在这项研究中，我们证明了CCeP阻滞在接受枕下手术的儿科患者中的新型应用的初步安全性和镇痛效果.需要更大的研究来进一步验证这种阻滞在儿童中的使用。
方法：在本前瞻性病例系列中，我们纳入了5例2~18岁因有症状的ChiariI型畸形接受手术的患者.在切口之前进行超声引导的宫颈平面（CCeP）阻滞。在计划的枕下减压和C1椎板切除术的水平上，将局部麻醉剂（布比卡因）和类固醇佐剂（地塞米松）注射到颈半腰肌和颈半腰肌之间的筋膜平面。在阻滞前后监测运动诱发电位和体感诱发电位。评估患者术中局部注射的并发症和术后疼痛。
结果：术中没有发现不良事件，神经监测信号没有变化。术后即刻疼痛评分较低，救援药物很少。在术后3个月随访时，没有发现切口疼痛或需要麻醉剂的抱怨。
结论：在这项研究中，我们证明了CCeP阻滞在接受枕下手术的儿科患者中的新型应用的初步安全性和镇痛效果.需要更大的研究来进一步验证这种阻滞在儿童中的使用。
