摘要
目的探讨超声引导下耳大神经阻滞(GANB)对中耳显微手术中瑞芬太尼血浆靶浓度的影响,评价其在中耳手术围术期少阿片或无阿片麻醉中的应用价值。方法选择2019年5月至2021年1月择期行中耳显微手术的患者66例,男35例,女31例,年龄18~60岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:超声引导下GANB组(B组)和对照组(C组),每组33例。B组在麻醉诱导前10 min超声引导下注射0.5%罗哌卡因2 ml阻滞患侧耳大神经;C组行单纯全麻。两组全麻方案和用药相同。术中维持丙泊酚7 mg·kg^(-1)·h^(-)1静脉输注,通过调整瑞芬太尼血浆靶浓度(Cp_(remi))维持HR 50~90次/分,SBP 95~125 mmHg。血流动力学指标达标并稳定后,此时Cp_(remi)为适宜浓度,维持此浓度至术毕。记录切皮后适宜Cp_(remi)和达到适宜Cp_(remi)后3 min的BIS,麻醉维持中瑞芬太尼和丙泊酚每小时用量和药物泵注时间,停药至喉罩拔除时间,PACU清醒后5 min、术后2、4、6 h NRS评分,术后6 h内补救镇痛例数。结果与C组比较,B组适宜Cp_(remi)明显降低(P<0.05),瑞芬太尼每小时用量明显减少(P<0.05),停药至喉罩拔除时间明显缩短(P<0.05),PACU清醒后5 min、术后2、4、6 h NRS评分明显降低(P<0.05),术后6 h内补救镇痛率明显降低(P<0.05)。两组达到适宜Cp_(remi)后3 min的BIS、丙泊酚每小时用量、药物泵注时间差异无统计学意义。结论超声引导下GANB可以降低中耳显微手术中瑞芬太尼的血浆靶浓度,减少瑞芬太尼的用量,缩短喉罩拔除时间,同时术后早期镇痛效果更好。
Objective To explore the effect of ultrasound-guided great auricular nerve block(GANB) on the target concentration of remifentanil and its clinical value to opioid-sparing anesthesia in middle ear microsurgery. Methods Sixty-six patients scheduled to undergo middle ear microsurgery, 35 males and 31 females, aged 18-60 years, BMI 18-28 kg/m^(2), ASA physical status Ⅰ or Ⅱ, were randomly assigned into two groups: ultrasound-guided GANB group(group B) and control group(group C), 33 patients in each group. Group B received GANB using 0.5% ropivacaine 2 ml under ultrasound guidance 10 minutes before general anesthesia induction. Group C received general anesthesia only. All patients received the same induction and maintain protocol of total intravenous anesthesia. Propofol 7 mg·kg^(-1)·h^(-1) was infused and remifentanil was infused to reach a target-controlled plasma concentration(Cp_(remi)), thus to maintain HR at 50-90 beats/minutes and SBP at 95-125 mmHg to meet the procedure demand until there was no ascending or descending tendency. This Cp_(remi)was sustained as an optimal concentration till the procedure was finished when infusion of propofol and remifentanil was stopped simultaneously. BIS were recorded 3 minutes after the optimal Cp_(remi)was reached. The infusion duration and consumption of remifentanil and propofol, laryngeal mask airway(LMA) removal time from infusion stop timepoint to LMA removal timepoint as well as the numerical rating scale(NRS) scores 5 minutes after fully consciousness in PACU, 2, 4, 6 hours after operation, and the incidence of remedial analgesia 6 hours after operation were recorded. ResultsCompared with group C, the optimal Cp_(remi)and per-hour consumption of remifentanil were significantly decreased(P < 0.05), LMA removal time was significantly shorterned(P < 0.05), the NRS scores 5 minutes after fully consciousness in PACU, 2, 4, and 6 hours after operation and the incidence of remedial analgesia 6 hours after operation were significantly decreased in group B(P < 0.05). There was no significant difference in BIS 3 minutes after Cp_(remi)was achieved, dosage of propofol per hour and infusion time between the two groups. Conclusion The target concentration of remifentanil is decreased by means of ultrasound-guided GANB in middle ear microsurgery. GANB reduces the consumption of remifentanil and LMA removal time and provides effective postoperative pain relief.
作者
刘金升
袁克志
包音
龚雨
李天佐
LIU Jinsheng;YUAN Kezhi;BAO Yin;GONG Yu;LI Tianzuo(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第6期594-597,共4页
Journal of Clinical Anesthesiology
基金
北京市科学技术委员会首都临床特色应用研究(Z181100001718107)。
关键词
超声
耳大神经
外周神经阻滞
瑞芬太尼
靶控输注
Ultrasound
Great auricular nerve
Peripheral nerve block
Remifentanil
Target-controlled infusion
