摘要
目的观察超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对腹腔镜肾切除术患者术后镇痛的影响。方法择期行腹腔镜肾切除术患者40例,男19例,女21例,年龄25~65岁,ASAⅠ或Ⅱ级,随机分为单纯全麻组(C组)和全麻联合RISS平面阻滞组(T组),每组20例。T组在麻醉诱导前行超声引导下患侧RISS平面阻滞,注射0.25%罗哌卡因30 ml,C组不行RISS平面阻滞。两组患者手术后均行PCIA。观察术后1、6、12、24、48 h静息及活动时VAS疼痛评分以及舒芬太尼用量、镇痛泵有效按压次数,记录术后48 h内不良反应或并发症情况。结果 T组术后1、6、12、24 h的静息和活动时VAS疼痛评分明显低于C组(P<0.05),舒芬太尼用量和镇痛泵有效按压次数明显少于C组(P<0.05)。两组均未观察到气胸、局麻药中毒、血肿、严重低血压等并发症。结论诱导前RISS平面阻滞可有效提高腹腔镜肾切除术后静脉自控镇痛的效果。
Objective To observe whether ultrasound-guided rhomboid intercostal and sub-serratus(RISS) plane block would improve postoperative analgesia in patients undergoing laparoscopic nephrectomy. Methods Forty adult patients undergoing elective laparoscopic nephrectomy, 19 males and 21 females, aged 25-65 years, ASA physical status Ⅰ or Ⅱ, were randomly assigned to receive either general anesthesia(group C) or general anesthesia with RISS block(group T), n = 20 for each group. Group T received 0.25% ropivacaine 30 ml preoperatively under ultrasound guidance of RISS block. All patients used patient-controlled intravenous analgesia(PCIA) postoperatively. Each patient′s postoperative pain score at rest and on movement based on a verbal numerical rating scale were evaluated at 1, 6, 12, 24 and 48 h after surgery. The amount of sufentanil and the number of effective compressions of PCIA at the above time point were recorded. The complications and adverse effects were also recorded. Results The postoperative pain scores, the amount of sufentanil and the number of effective compressions of PCIA were significantly lower in group T than in group C at 1, 6 12 and 24 h after surgery(P < 0.05). There were no complications including pneumothorax, local anesthetic intoxication, severe hypotension, hematoma observed. Conclusion Therhomboid intercostals and sub-serratus plane block combined with patient-controlled intravenous analgesia can provide effective analge sia for perioperative pain management in laparoscopic nephrectomy.
作者
侯雪琦
柴彬
林文新
李世英
马保新
HOU Xueqi;CHAI Bin;LIN Wenxin;LI Shiying;MA Baoxin(Department of Anesthesiology,Zhongshan Hospital of Xiamen University,Xiamen 361004,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第4期322-325,共4页
Journal of Clinical Anesthesiology
