目的 评估超声引导下单次注射肋间神经阻滞（intercostal nerve block，ICNB）和胸椎旁阻滞（paravertebral block，PVB）对于接受耳廓再造自体肋软骨移植术的小耳畸形患儿的阿片类用量和术后镇痛的影响。 方法 择期行耳廓再造自体肋软骨移植术患儿120名，按照区组随机法分为3组（每组40例）：单纯全麻组（GA组）、超声引导下肋间神经阻滞组（ICNB组）和超声引导下椎旁神经阻滞组（PVB组）。GA组仅接受全身麻醉；ICNB组和PVB组均在麻醉诱导后使用利多卡因单次神经阻滞。3组患者术后均接受48 h的静脉自控镇痛（patient-controlled intravenous analgesia，PCIA）。记录术中阿片类用量、各时间点的心率（heart rate，HR）和平均动脉压（mean arterial pressure，MAP）；评估首次获得视觉模拟评分法（visual analogue scale，VAS）评分时间和麻醉复苏室（postanesthesia care unit，PACU）停留时间；记录术后48 h内静息和深呼吸时的VAS疼痛评分；比较3组患儿术后48 h内患者阿片类用量和术后镇痛相关不良反应（包括恶心呕吐、瘙痒和低氧）。 结果 与GA组相比，ICNB组和PVB组的术中阿片类用量（P=0.02，P<0.01）、首次获得VAS评分时间（P<0.01，P=0.02）、PACU停留时间（P<0.01，P<0.01）、取第一根肋软骨时的HR（P=0.04，P<0.01）均显著降低，但ICNB和PVB组之间差异无统计学意义；在术后的疼痛评分、阿片类用量及镇痛相关不良反应方面，3组差异无统计学意义。 结论 使用利多卡因行超声引导下单次ICNB和PVB均可减少耳廓再造自体肋软骨移植患儿术中阿片类用量、维持术中血流动力学稳定和加快苏醒，但不能减轻术后疼痛。

Objective To evaluate the consumption of opioid and postoperative analgesia of intercostal nerve block （ICNB） and paravertebral block （PVB） for autologuous rib cartilage graft for auricular reconstruction in children with microtia. Methods A total of 120 patients scheduled for autologuous rib cartilage graft for auricular reconstruction were enrolled. According to randomized blocks， patients were allocated into three groups （n=40 in each group）：general anesthesia group （GA group）， ultrasound-guided intercostal nerve block group （ICNB group） and ultrasound-guided PVB group （PVB group）. GA group only received general anesthesia， while ICNB group and PVB group received single-shot nerve block with lidocaine after induction of general anesthesia. All groups were received patient-controlled intravenous analgesia （PCIA） for 48 hours postoperatively. Intraoperative opioid requirement was recorded. Heart rate （HR） and mean arterial pressure （MAP） were recorded at different time points during surgery. Time of the first visual analogue scale （VAS） obtained and duration of postanesthesia care unit （PACU） stay were evaluated. The VAS scores of chest and ear during deep breath and at rest were recorded during 48 hours postoperatively. Opioid consumption and postoperative analgesia-related adverse events were compared among the three groups during 48 hours after surgery. Results Compared with those in GA group， intraoperative fentanyl consumption（P=0.02，P<0.01）， time of the first VAS obtained （P<0.01，P=0.02）， duration of PACU stay （P<0.01，P<0.01） and HR when harvesting the first rib cartilage （P=0.04，P<0.01） were statistically lower in ICNB group and PVB group than those in GA group， but no statistical difference was found between these two groups. There were no statistical differences in VAS scores， opioid consumption and analgesia-related adverse events among the three groups. Conclusion Ultrasound-guided single-shot ICNB and PVB with lidocaine provide similar efficacy of reducing intraoperative opioid consumption， maintaining intraoperative hemodynamic stability and faster awakening， but fail to alleviate postoperative pain.