Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2023, Vol. 37 ›› Issue (1): 15-19.doi: 10.6040/j.issn.1673-3770.0.2021.538

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Effect of great auricular nerve block on emergence delirium in children undergoing cochlear implantation

FENG Yanyan1, ZHANG Danxu1, ZHANG Kangda1, WANG Linyu1, WANG Huanliang1,2,3   

  1. 1. Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250014, Shandong, China;
    2. Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570100, Hainan, China;
    3. Shenzhen Research Institute of Shandong University, Shenzhen 518000, Guangdong, China
  • Published:2023-02-06

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Abstract: Objective To evaluate the effect of great auricular nerve block on emergence delirium(ED)in children undergoing cochlear implantation with sevoflurane general anesthesia. Methods We enrolled 80 children(0-6 years)with American Society of Anesthesiologists status Ⅰ or Ⅱ who were scheduled for unilateral cochlear implantation under sevoflurane general anesthesia. The patients were randomly assigned to the great auricular nerve block group(group A)or the control group(group B). After the induction of anesthesia, 1 mL of 0.2% ropivacaine was injected around the auricular nerve under ultrasound guidance in group A, while 2 mL of 2% lidocaine was injected around the incision in group B. General anesthesia was maintained with sevoflurane. The incidence of ED was assessed using the pediatric anesthesia acute delirium scale(PAED), while postoperative pain was assessed using the face, legs, activity, cry and consolability(FLACC)scale. Patients with a PAED≥13 or FLACC≥4 were given fentanyl 0.5 μg/kg intravenously. Average sevoflurane dosage, ED duration, extubation time, duration of post-anesthesia care unit(PACU)stay, total fentanyl dosage, nurse satisfaction score, and incidence of adverse reactions within 24 hours postoperative were recorded. Results The incidence of ED(P=0.036)and PAED(P=0.024)score were significantly decreased in group A versus B, FLACC score(P=0.008)and the incidence of FLACC≥4(P=0.006)were significantly decreased, the incidence of analgesia with fentanyl(P=0.011)was significantly decreased, duration of PACU(P=0.040)residence was significantly shortened, and nurse satisfaction(P=0.021)was significantly improved(all P<0.05). No significant change was found in group A in the incidence of PAED≥13(P=0.289), ED duration(P=0.962), extubation time(P=0.913), and the incidence of postoperative adverse reactions(PVomit=0.737;Pchoking=0.487;Phypoxia=1.000)(all P>0.05). Conclusion A great auricular nerve block can reduce the incidence of ED and postoperative pain in children under sevoflurane general anesthesia without increasing the incidence of postoperative adverse events.

Key words: Emergence delirium, Great auricular nerve block, Child, Cochlear implantation, Postoperative pain

CLC Number: 

  • R614.4
[1] Chen WS, Chiang MH, Hung KC, et al. Adverse respiratory events with sevoflurane compared with desflurane in ambulatory surgery: a systematic review and meta-analysis[J]. Eur J Anaesthesiol, 2020, 37(12): 1093-1104. doi:10.1097/EJA.0000000000001375
[2] Locatelli BG, Ingelmo PM, Emre S, et al. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale[J]. Paediatr Anaesth, 2013, 23(4): 301-308. doi:10.1111/pan.12038
[3] Chen JY, Jia JE, Liu TJ, et al. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children[J]. J Can D'anesthesie, 2013, 60(4): 385-392. doi:10.1007/s12630-013-9886-x
[4] Wang H, Liu G, Fu W, et al. The effect of infraorbital nerve block on emergence agitation in children undergoing cleft lip surgery under general anesthesia with sevoflurane[J]. Paediatr Anaesth, 2015, 25(9): 906-910. doi:10.1111/pan.12674
[5] Somaini M, Sahillioglu E, Marzorati C, et al. Emergence delirium, pain or both? A challenge for clinicians[J]. Paediatr Anaesth, 2015, 25(5): 524-529. doi:10.1111/pan.12580
[6] Jooma Z, Perrie H, Scribante J, et al. Emergence delirium in children undergoing dental surgery under general anesthesia[J]. Paediatr Anaesth, 2020, 30(9): 1020-1026. doi:10.1111/pan.13937
[7] Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale[J]. Anesthesiology, 2004, 100(5): 1138-1145. doi:10.1097/00000542-200405000-00015
[8] Urits I, Peck J, Giacomazzi S, et al. Emergence delirium in perioperative pediatric care: a review of current evidence and new directions[J]. Adv Ther, 2020, 37(5): 1897-1909. doi:10.1007/s12325-020-01317-x
[9] 刘金升, 潘楚雄, 周洪玲, 等. 超声引导耳大神经阻滞联合全麻用于成年患者中耳显微手术的效果[J]. 中华麻醉学杂志, 2018, 38(5): 555-557. doi:10.3760/cma.j.issn.0254-1416.2018.05.012 LIU Jinsheng, PAN Chuxiong, ZHOU Hongling, et al. Efficacy of ultrasound-guided great auricular nerve block combined with general anesthesia for middle ear microsurgery in adult patients[J]. Chinese Journal of Anesthesilolgy, 2018, 38(5): 555-557. doi:10.3760/cma.j.issn.0254-1416.2018.05.012
[10] Liu JS, Yuan KZ, Zhou HL, et al. A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery[J]. BMC Anesthesiol, 2020, 20(1): 234. doi:10.1186/s12871-020-01155-y
[11] Crellin DJ, Harrison D, Santamaria N, et al. The psychometric properties of the FLACC scale used to assess procedural pain[J]. J Pain, 2018, 19(8): 862-872. doi:10.1016/j.jpain.2018.02.013
[12] Zhang H, Fan Q, Zhang JF, et al. Effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery: study protocol for a randomized controlled trial[J]. Trials, 2019, 20(1): 22. doi:10.1186/s13063-018-3140-3
[13] Merkel S, Voepel-Lewis T, Malviya S. Pain assessment in infants and young children: the FLACC scale[J]. Am J Nurs, 2002, 102(10): 55-58. doi:10.1097/00000446-200210000-00024
[14] Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions[J]. Korean J Anesthesiol, 2020, 73(6): 471-485. doi:10.4097/kja.20097.
[15] Koch S, Rupp L, Prager C, et al. Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: an observational study[J]. Eur J Anaesthesiol, 2018, 35(12): 929-936. doi:10.1097/EJA.0000000000000867
[16] 胡春燕, 党攀红, 张睿, 等. 儿童单侧感音性听力损失的听力学及影像学特征149例分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 31-36. doi: 10.6040/j.issn.1673-3770.0.2021.418. HU Chunyan, DANG Panhong, ZHANG Rui, et al. Analysis of audiological and imaging characteristics of 149 children with unilateral sensorineural hearing loss[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 31-36. doi: 10.6040/j.issn.1673-3770.0.2021.418
[17] 高芳芳, 王启荣, 于淑东, 等. 人工耳蜗植入术295例语言康复临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 62-65. doi: 10.6040/j.issn.1673-3770.0.2017.425 GAO Fangfang, WANG Qirong, YU Shudong, et al. Clinical analysis of language rehabilitation in 295 cases of cochlear implantation[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 62-65. doi: 10.6040/j.issn.1673-3770.0.2017.425
[18] Choi EK, Lee S, Kim WJ, et al. Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia[J]. Paediatr Anaesth, 2018, 28(8): 739-744. doi:10.1111/pan.13446
[19] Lee YJ, Kim BY, Park JH, et al. The effect of intraoperative magnesium sulphate infusion on emergence agitation after ambulatory ophthalmic surgery in children[J]. J Clin Med, 2020, 9(12): E4126. doi:10.3390/jcm9124126
[20] Choi EK, Park S, Park KB, et al. Postoperative emergence agitation and intraoperative sevoflurane sedation under caudal block in children: a randomized comparison of two sevoflurane doses[J]. Anesth Pain Med(Seoul), 2019, 14(4): 434-440. doi:10.17085/apm.2019.14.4.434
[21] Xu N, Chen Q, Huang ST, et al. Sufentanil reduces emergence delirium in children undergoing transthoracic device closure of VSD after sevoflurane-based cardiac anesthesia[J]. Braz J Cardiovasc Surg, 2020, 35(5): 660-665. doi:10.21470/1678-9741-2019-0334
[22] Tan Y, Shi YS, Ding H, et al. M-Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: a meta-analysis of randomized controlled trials[J]. Paediatr Anaesth, 2016, 26(2): 139-150. doi:10.1111/pan.12815
[23] Hesse S, Kreuzer M, Hight D, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications[J]. Br J Anaesth, 2019, 122(5): 622-634. doi:10.1016/j.bja.2018.09.016
[24] Khalil SN, Matuszczak ME, Maposa D, et al. Presurgical fentanyl vs caudal block and the incidence of adverse respiratory events in children after orchidopexy[J]. Paediatr Anaesth, 2009, 19(12): 1220-1225. doi:10.1111/j.1460-9592.2009.03164.x
[25] Suresh S, Barcelona SL, Young NM, et al. Postoperative pain relief in children undergoing tympanomastoid surgery: is a regional block better than opioids? [J]. Anesth Analg, 2002, 94(4): 859-862, tableofcontents. doi:10.1097/00000539-200204000-00015
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