摘要
目的评价超声引导下前锯肌平面阻滞用于胸腔镜手术患者术后镇痛的效果。方法择期全麻下行胸腔镜手术患者60例,年龄18~64岁,BMI 18~24 kg/m^2,ASA分级Ⅰ或Ⅱ级,性别不限。采用随机数字表法分为3组(n=20):对照组(C组)、胸椎旁神经阻滞组(PVB组)和前锯肌平面阻滞组(SAPB组)。健侧卧位后,PVB组超声引导下于患侧T4,6胸椎旁各注入0.25%罗哌卡因20 ml。SAPB组超声引导下行患侧前锯肌平面阻滞,注入0.33%罗哌卡因30 ml。术毕行PCIA,术后NRS>3分时按压PCIA泵,效果欠佳时静脉注射氟比洛芬酯2 mg/kg。于术后3 d时记录PCIA按压情况,PCIA总用量和氟比洛芬酯使用情况。记录术中舒芬太尼用量并计算剂量,记录舒芬太尼总用量。观察术后恶心呕吐、肺部感染和慢性疼痛的发生情况。结果与C组比较,PVB组和SAPB组术中舒芬太尼用量、剂量、总用量、PCIA按压次数、总用量和术后恶心呕吐发生率降低(P<0.05);与PVB组比较,SAPB组各指标差异无统计学意义(P>0.05)。3组慢性疼痛的发生率差异无统计学意义(P>0.05),均未追加氟比洛芬酯。结论超声引导下前锯肌平面阻滞用于胸腔镜手术患者术后镇痛效果好,不良反应少。
Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block(SAPB)for postoperative analgesia in patients undergoing thoracoscopic surgery.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m^2,scheduled for elective thoracoscopic surgery under general anesthesia,were divided into 3 groups(n=20 each)using a random number table method:control group(group C),thoracic paravertebral block(PVB)group(group PVB)and group SAPB.After the patients were turned to contralateral position,thoracic PVB was performed at T4,6 thoracic vertebrae on the affected side under ultrasound guidance,and 0.25%ropivacaine 20 ml was injected in group PVB.In group SAPB,ultrasound-guided SAPB was performed on the affected side,and 0.33%ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia(PCIA)was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores>3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing,total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded,the dose was calculated,and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting,pulmonary infection and chronic pain was also recorded.Results Compared with group C,the consumption,dose and total consumption of sufentanil were significantly decreased,the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased,and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups(P<0.05).Compared with group PVB,no significant change was found in the parameters in group SAPB(P>0.05).There was no significant difference in the incidence of chronic pain among the three groups(P>0.05),and no patients required additional flurbiprofen axetil.Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects.
作者
黄鹤
张熙哲
乔青
冯艺
Huang He;Zhang Xizhe;Qiao Qing;Feng Yi(Ruijin North Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201800,China;Peking University People′s Hospital,Beijing 100044,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第5期565-567,共3页
Chinese Journal of Anesthesiology
