国际麻醉学与复苏杂志   2018, Issue (10): 12-12
    
胸神经阻滞对乳腺癌改良根治术术后镇痛效果的评价
祁富伟, 张文娟, 沈健, 杨广宇, 何静, 费凡, 郭强, 郑重, 赵秀华1()
1.江苏省太仓市第一人民医院
Effect of ultrasound-guided pectoral nerves block on postoperative analgesia in patients undergoing modified radical mastectomy
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摘要:

目的 评价超声引导胸神经(pectoral nerves, Pecs)阻滞对乳腺癌改良根治术术后镇痛的效果。 方法 择期行单侧乳腺癌改良根治术的患者60例,ASA分级Ⅰ、Ⅱ级,采用随机数字表法将患者分为两组(每组30例):全身麻醉复合胸神经阻滞组(P组)和单纯全身麻醉组(C组)。P组患者在实施全身麻醉前,联合Pecs阻滞方法行超声引导下Pecs阻滞,于胸大肌与胸小肌之间、胸小肌与前锯肌之间分别注入0.375%罗哌卡因10 ml和20 ml。术后均采用舒芬太尼行患者自控静脉镇痛(patient-controlled intravenous analgesia, PCIA)。记录术中瑞芬太尼及丙泊酚总用量,记录术后24 h内舒芬太尼总用量及有效按压次数(D1)和实际按压次数(D2),并计算D1/D2,记录术后2、4、8、12、24 h患者静息及运动VAS评分、Ramsay镇静评分,记录恶心、呕吐等相关副作用发生情况。 结果 与C组比较,P组患者术后2、4、8、12 h静息及运动VAS评分降低(P<0.05),Ramsay镇静评分差异无统计学意义(P>0.05)。P组术中瑞芬太尼及术后24 h内舒芬太尼总用量少于C组,D1/D2升高(P<0.05)。P组恶心、呕吐的副作用少于C组(P<0.05)。 结论 超声引导Pecs阻滞可减少乳腺癌改良根治术术后阿片类药物用量,增强术后镇痛效果,减少相关副作用的发生。AS评分明显降低,Ramsay评分无统计学差异。Pecs组术中及术后24h内舒芬太尼总用量明显少于C组,D1/D2明显升高(P<0.05)。两组均未见恶心、呕吐等不良反应。 结论:超声引导胸神经阻滞可减少乳腺癌改良根治术术后阿片类药物用量,增强术后镇痛效果,减少相关不良反应。

关键词: 胸神经; 神经阻滞; 乳腺癌改良根治术; 术后镇痛
Abstract:

Objective To evaluate the postoperative analgesic effect of ultrasound-guided pectoral nerves(Pecs) block in patients undergoing modified radical mastectomy. Methods Sixty adult female patients, ASA gradeⅠorⅡ, scheduled for elective unilateral modified radical mastectomy under general anesthesia were randomly allocated to receive either general anesthesia (combination of sufentanil, remifentanil and propofol) plus Pecs block(group P, n=30) or general anesthesia only(group C, n=30). Patients in group P received ultrasound guided Pecs block with infiltration of 10 ml and 20 ml of 0.375% ropivacaine into fascial planes between pectoralis major and minor muscles, and between pectoralis minor and serratus anterior muscles, respectively before general anesthesia. Patient-controlled intravenous analgesia(PCIA) with sufentanil was used for postoperative pain management. Intraoperative consumption of sufentanil, remifentanil and propofol were recorded. Sufentanil consumption, the effective (D1) and total (D2) pressing times of PCIA within 24 h after surgery were recorded, and D1/D2 ratio was calculated. The VAS scores and Ramsay sedation score at rest and movement as well as other adverse reactions such as the incidence of nausea and vomiting 2, 4, 8, 12, 24 h after operations were recorded. Results Compared with patients in the group C, patients in group P showed lower VAS scores (P<0.05) and similar Ramsay score 2, 4, 8, 12 h after operation. Consumption of intraoperative remifentanil and postoperative sufentanil within 24 h in group P was significantly less than those in group C, and the ratio of D1 and D2 was significantly increased in group P compared with group C (P<0.05). The incidence of adverse events such as nausea and vomiting in group P was less than that in group C(P<0.05). Conclusions The Pecs block is a simple feasible technique to produce satisfying postoperative analgesia for radical breast surgery.

Key words: Pectoral nerves; Nerve block; Modified radical mastectomy; Postoperative analgesia