Application Of Multimodal Analgesia Based On Compound Lidocaine Cream In Pediatric Circumcision

Objective:To observe the analgesic effect of multimodal analgesia based on compound lidocaine cream in children's circumcision,so as to explore a method which is easy to be accepted by children and their families with good analgesic effect and little side effects.Methods: Male children who underwent circumcision at New Century Women's and Children's Hospital of Chengdu from May 2019 to February 2020 were selected,aged 5-7 years,according to the wishes of their families,they were divided into two anesthesia methods: local injection anesthesia of traditional dorsal lidocaine and local application of compound lidocaine cream and combined anesthesia.lidocaine cream apply surface infiltration group as experimental group(A): Compound lidocaine cream was anesthetized 1 hour before the operation,at the same time,paracetamol granules 15mg/Kg were administered orally.30 minutes later,apply the compound lidocaine surface anesthesia again,and play the video of interest with iPad or mobile phone while waiting and during the operation until the end of the operation;Conventional injection of lidocaine for penile dorsal nerve block anesthesia was used as the control group(group B),preoperative and intraoperative routine nursing.Thirty people were randomly selected from each group.Theexperimental group and control group were divided into A1,A2,B1 and B2 groups according to the redundant prepuce and phimosis,respectively.Preoperative anxiety scores were obtained at three time points when the children were waiting in the waiting room(T1),when they entering the operating room(T2),and before anesthesia(T3).Heart rate(HR),respiratory rate(RR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)were recorded at the quiet state before surgery(T0),at the beginning of surgery(T1),at the time of band ligation(T2),at the time of foreskin cutting(T3),and at the end of operation(T4).Record pain scores at the time of anesthesia(T0),at the beginning of the operation(T1),at the time of foreskin cutting(T2),at the end of the operation(T3),30 minutes after operation(T4),1 hour after operation(T5),2 hours after operation(T6),and 3 hours after operation(T7).The pain assessment method was self-assessment combined with behavioral assessment(Self-evaluation: Wang-Baker facial expression scale;behavioral assessment: FLACC Scale);Record the duration of postoperative analgesia,remedy analgesia within 24 hours after operation,complications such as postoperative bleeding,foreskin edema,and bradycardia,hypotension,methemoglobinemia,and other local anesthetic poisons situation of side reactions.The above indicators were statistically analyzed by SPSS 24.0,and there was statistical significance at P< 0.05.The anesthesia method was informed by the family members of the children.The medical ethics issue was discussed and approved by theEthics Committee of New Century Women's and Children's Hospital of Chengdu.Results:(1)General indicators There was no significant difference in the age,height,weight,operation time,redundant prepuce and phimosis component ratio between children in group A and group B(P>0.05);(2)Preoperative Anxiety Score The anxiety scores of group A in the waiting area(T1),the time of entering the operating room(T2),and before anesthesia(T3)were lower than group B before surgery(P <0.05);(3)Hemodynamic changes Heart rate: Comparison between group A and group B: Group A had lower heart rate than group B at the beginning of surgery(T1),at the time of band ligation(T2),at the time of foreskin cutting(T3),and at the end of surgery(T4)(P < 0.05).Comparison between group A1 and group B1: At the beginning of surgery(T1),at the time of band ligation(T2),at the time of foreskin cutting(T3),the heart rate of children in group A1 was lower than B1 Group(P < 0.05);Comparison between group A2 and group B2: At the beginning of surgery(T1),at the time of foreskin cutting(T3),the heart rate of children in group A2 was lower than group B2(P<0.05);Respiration:Comparison between group A and group B,and between group A1 and group B1,and between group A2 and group B2: There are two time points at the beginning of surgery(T1)and at the time of band ligation(T2),the respiratory rate of children in group B,group B1,and group B2 was higher than that of group A,group A1 and group A2,respectively(P<0.05);Systolic blood pressure: Comparison between group A and group B,and between group A2 and group B2: there are four time points,at the beginning of the operation(T1),at the time of band ligation(T2),at the time of foreskin cutting(T3),and at the end of the operation(T4),systolic blood pressure in group A and A2 was lower than group B and group B2,respectively(P < 0.05).Comparison between group A1 and group B1: At the beginning of the operation(T1),at the time of band ligation(T2),and at the end of the operation(T4),systolic blood pressure in group A1 was lower than that in group B1(P<0.05).Diastolic blood pressure: Compared with group B: At the beginning of surgery(T1),at the time of band ligation(T2),and at the end of surgery(T4),children in group B had higher diastolic blood pressure than those in group A(P<0.05).Comparison between group A1 and group B1: At the time of band ligation(T2),the diastolic blood pressure in group A1 was lower than that in group B1(P<0.05).Comparison between group A2 and group B2: At the end of surgery(T4),the diastolic blood pressure of children in group A2 was lower than that in group B2(P<0.05).(4)FLACC score Comparison between group A and group B: At the time of anesthesia(T0),at the beginning of surgery(T1),at the time of foreskin cutting(T2),30 minutes after surgery(T4),1 hour after surgery(T5),2 hours after surgery(T6)and 3 hours after surgery(T7),theFLACC score of group B was higher than that of group A(P <0.05).Comparison between group A1 and group A2: At the time of anesthesia(T0),the FLACC score of group A1 was lower than that in group A2(P<0.05);Compared with group B1 and group B2: 1 hour after surgery(T5),2 hours after surgery(T6),and 3 hours after surgery(T7),the FLACC score of group B1 was lower than that of group B2(P<0.05);Comparison between group A1 and group B1: at the time of anesthesia(T0),at the beginning of surgery(T1),30 minutes after surgery(T4),1hour after surgery(T5),2 hours after surgery(T6),FLACC in group B1 The score was higher than the A1 group(P<0.05);Comparison between group A2 and group B2: at the time of anesthesia(T0),1 hour after surgery(T5),2 hours after surgery(T6),3 hours after surgery(T7),The FLACC score of group B2 was higher than that of group A2(P <0.05);(5)Wong-Baker score Comparison between group A and group B: at the time of anesthesia(T0),at the beginning of surgery(T1),at the time of foreskin cutting(T2),1 hour after surgery(T5),2 hours after surgery(T6),and 3 hours after surgery(T7),the score of Wong-Baker in group B was higher than that in group A(P<0.05).Comparison between group A1 and group A2: during anesthesia(T0),the Wong-Baker score of group A1 was lower than that of group A2(P<0.05).Comparison between group B1 and group B2: at the time of foreskin cutting(T2),1 hour after surgery(T5),2 hours after surgery(T6),and 3 hours after surgery(T7),Wong-Baker score of group B1 was lower than that of group B2(P<0.05).Comparison between group A1 and group B1: at the time of anesthesia(T0),at the beginning of surgery(T1),1 hour after surgery(T5),2 hours after surgery(T6),the score of Wong-Baker in group B1 was higher than that in group A1(P < 0.05).Comparison between A2 group and B2 group: at the time of anesthesia(T0),at the time of foreskin cutting(T2),1 hour after surgery(T5),2 hours after surgery(T6),3 hours after surgery(T7),the score of Wong-Baker in B2 group was higher than that in A2 group(P<0.05).(6)Postoperative analgesia The duration of postoperative analgesia in the experimental group(group A,group A1,group A2)was significantly longer than that in the control group(group B,group B1,group B2),and the proportion of remedial analgesia measures in the experimental group(group A,group A1,group A2)was lower than that in the control group(group B,group B1,group B2)24 hours after the operation(P<0.05);(7)Adverse reactions There was no significant difference in postoperative bleeding between the two groups(P>0.05).The incidence of foreskin edema in group B was greater than that in group A(P< 0.05).In both groups,no local anesthetic drugs caused bradycardia,hypotension,methemoglobinemia and other side effects occurred.Conclusion: The application of multimodal analgesia based on compound lidocaine cream in circumcision has good analgesic effects intraoperative and postoperative,with high safety and no obvious adverse reactions,no matter for the children with redundant prepuce or phimosis.