Efficacy Of Dexmedetomidine Mixed With Local Anesthetic For Ilioinguinal/Iliohypogastric Nerve Blocks Combined LMA General Anesthesia On Unilateral Hernia Surgery In Children

Background:Indirect hernia surgery is a common operation in children clinically.Its operation time is short and noxious stimulation for patients is slight.The requirements of an anesthesia method featured with rapid induction, easy to control anesthesia depth, speedy anesthesia recovery, less morbidity, security and not high requirement of muscle relaxation are needed. Laryngeal mask intubation inhales sevoflurane general anesthesia as a general anesthesia,air way responsiveness is small, anesthesia induction and recovery is quick, with simple operation, combining iliohypogastric/ilioinguinal nerve blocks can reduce the action of analgesics and muscle relaxant. It has a certain advantages used for indirect hernia surgery in children.Dexmedetomidine mixed with local anesthetics can be safely and effectively used for blocks in brachial plexus, canalis sacralis, palatine nerve and so on. While the efficacy of dexmedetomidine mixed with local anesthetic for ilioinguinal iliohypogastric nerve blocks combined LMA general anesthesia on unilateral hernia surgery in children is still unknow.Our study observes it for this Objective:To evaluate the efficacy of dexmedetomidine mixed with local anesthetic for ilioinguinal/iliohypogastric nerve blocks combined LMA general anesthesia on unilateral hernia surgery in children.MethodsFifty ASA I or II pediatric patients of both sexes,aged2-5yr,weighing9-20kg,scheduled for unilateral hernia surgery,were randomly divided into2groups(n=25each):local anesthetic group(group L) and dexmedetomidine mixed with local anesthetic group(group DL).Anesthesia was induced with inhalation of6%-8%sevoflurane,the appropriate LMA was intubated after the jaw relaxed and spontaneous respirations was retained.The ilioinguinal/iliohypogastric nerve blocks were performed by the same senior anesthesiologists after intubation of LMA.The0.6ml/kg mixture of0.8%lidocaine and0.25%levobupivacaine was injected in group L,while the0.6ml/kg mixture of0.8%lidocaine,0.25%levobupivacaine and1μg/kg dexmedetomidine was injected in group DL.End-tidal concentration of sevoflurane was maintained at1.5%-2%during operation.The inhaled concentration of sevoflurane was adjusted and0.5μg/kg fentanyl was injected intravenously if the body response of pediatric patient happened or HR increased more than20%.LMA was removed when the end-tidal concentration of sevoflurane was more than1%after operation.If CHIPPS score of the padiatric patient was more than3in PACU,0.5μg/kg fentanyl was injected intravenously for analgesia,while0.05g indomethacin via Rectal administration was given in ward.EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.The operation time,recovery time,useage of fentanyl at the time of skin incision,useage of fentanyl in PACU,and useage of indomethacin within2,4and6h after operation were recorded.The occurrence of related complication was recorded.Results:Compared with group L,recovery time of the pediatric patients in group DL is increased; usage rate of fentanyl at the time of skin incision and the usage rate of indometacin within4and6h after operation are decreased; PAED scores and incidence of EA are decreased (P<0.05); the usage rate of fentanyl in the PACU and usage rate of indometacin within2hours after operation has no significant difference(P>0.05). The complications,e,g,bradycardia and laryngospasm during operation,nausea and vomiting after operation, have no significant difference(P>0.05).Conclusion:1μg/kg dexmedetomidine mixed with local anesthetics for iliohypogastric/ilioinguinal nerve blocks shortens the onset time, improves effect and prolongs duration time of local anesthetics.Combined LMA inhalation anesthesia can be safely and effectively used for unilateral indirect hernia surgery in children.