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新生児割礼のリングブロック,背側ペニル神経ブロック,局所麻酔の比較:ランダム化制御試験
J Lander1, B Brady-Fryer, J B Metcalfe
1Faculty of Medicine, University of Alberta, Edmonton, Canada. janice.lander@ualberta.ca
JAMA
|January 7, 1998
まとめ
リングブロックは,新生児の割礼に最も効果的な麻酔を提供し,泣き声と心拍の上昇を大幅に軽減しました. 局所的なEMLAは最も効果が低く,乳児の手続き中に痛み管理の必要性を強調しました.
科学分野:
- 新生児の介護について
- 小児外科手術について
- 痛みの管理 痛みの管理
背景:
- 現在の慣行では,麻酔の安全性と有効性に関する信念のために,新生児割礼の麻酔をしばしば省略しています.
- これにより,多くの新生児は,手術中に痛みを和らげることができません.
研究 の 目的:
- 新生児割礼におけるリングブロック,背面ペニル神経ブロック,局所EMLAの有効性をプラセボと比較するために.
- 手術中のおよび後の痛みと生理学的反応を評価するために.
主な方法:
- 52人の健康な,満期の男性新生児を対象としたランダム化制御試験.
- 割礼のさまざまな段階において,心拍数,泣き声,およびメーテモグロビンレベルをモニタリングする.
- リングブロック,背側ペニル神経ブロック,局所的なEMLA,無麻酔プラセボを比較した.
主要な成果:
- プラセボ群の新生児は,持続的な心拍数上昇と泣く症状を示し,2人は窒息と無呼吸を経験しました.
- 麻酔を受けたすべてのグループは,プラセボと比較して,泣き声と心拍数が減ったことを示しました.
- リングブロックは全体的に効果的であったが,背部のペニル神経ブロックとEMLAは,前皮の分離時に効果的ではなかった.
結論:
- リングブロックは,新生児割礼の最も効果的な麻酔剤です.
- 局所的なEMLAは,最も効果が低いことを示した.
- 麻酔投与は,割礼を受けるすべての新生児に推奨されます.
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