乳腺癌根治术经超声引导术侧前锯肌平面阻滞技术在术后镇痛中的效果分析

摘要

目的 分析乳腺癌根治手术经超声引导术侧前锯肌平面(SP)的阻滞技术在患者术后镇痛中的效果.方法 2013年1月至2016年12月择期接受全身麻醉下乳腺癌根治手术的68例患者,采用随机数字表法将患者均分为SP阻滞组(观察组,34例)及对照组(34例).麻醉诱导成功后经超声引导施行术侧SP阻滞,观察组注射20 ml的0.375%罗哌卡因,对照组注射等量0.9%氯化钠注射液,术后两组均给予舒芬太尼患者自控静脉镇痛(PCIA).分别于术后2、4、8、12、24 h(分别为T1、T2、T3、T4、T5)作Prince-Henry疼痛量表评分(PHPS评分),计算术中瑞芬太尼和术后24 h内舒芬太尼的用量,并计算24 h内有效的PCIA泵按压次数(D1)与实际按压次数(D2)的比值(D1/D2),同时记录不良反应情况.结果 与对照组比较,观察组的PHPS评分在T1[(1.4±0.5)分比(3.1±0.6)分]、T2[(1.5±0.6)分比(2.9±0.8)分]、T3[(1.7±0.5)分比(2.8±0.7)分]均明显下降(P<0.05);且观察组瑞芬太尼术中用量[(288.7±42.1)μg比(376.5±61.6)μg]、舒芬太尼术后24 h内用量[(53.4±16.7)μg比(87.8±24.5)μg]明显减少(P<0.05),且D1/D2值(0.89±0.12比0.57±0.18)明显升高(P<0.05);观察组术后相关不良反应发生率也明显降低[0比20.6%(7/34)](P<0.05).结论 乳腺癌根治手术经超声引导施行术侧SP阻滞可减轻患者术后早期的疼痛感,且加强了术后镇痛的效果并降低阿片类药物使用量.%Objective To investigate the effect of ultrasound-guided serratus plane block onefficacy of postoperative analgesia in patients undergoing radical mastectomy. Methods From January 2013 to December 2016, sixty-eight ASA physical statusⅠorⅡ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n = 34 each): SP block group (observation group) and control group. After induction of anesthesia, ultrasound-guided homolateral SP block was performed, and 0.375% ropivacaine 20 ml was injected in observation group, while the equal volume of normal saline was used instead in control group. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in two groups. The scores of prince henry pain scale (PHPS) were evaluated at the 2nd, 4th, 8th, 12th and 24th hour (T1, T2, T3, T4, T5) after operation. The consumption of sufentanil, propofol and remifentanil was recorded.Meantime, the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up, and D1/D2 was calculated. The adverse effects were also recorded. Results The scores of PHPS at T1 [(1.4 ± 0.5) scores vs. (3.1 ± 0.6) scores], T2 [(1.5 ± 0.6) scores vs. (2.9 ± 0.8) scores], T3 [(1.7 ± 0.5) scores vs. (2.8 ± 0.7) scores], and the consumption of sufentanil [(53.4 ± 16.7)μg vs. (87.8 ± 24.5)μg], remifentanil[(288.7 ± 42.1)μg vs. (376.5 ± 61.6)μg] were significantly lower in observation group than those in control group, while D1/D2 (0.89 ± 0.12 vs. 0.57 ± 0.18) was higher (P<0.05). The incidence of adverse reactions was significantly lower in observation group: 0 vs. 20.6% (7/34), P<0.05. Conclusions Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.