摘要
目的比较竖脊肌平面阻滞(ESPB)与单点胸椎旁阻滞(TPVB)用于乳腺癌根治术围术期镇痛的效果。方法择期行乳腺癌根治术的女性患者80例,年龄28~65岁,BMI<35 kg/m 2,ASAⅠ或Ⅱ级。采用随机数字法分为两组:ESPB组和TPVB组,每组40例。ESPB组和TPVB组分别在麻醉诱导前行患侧超声引导下竖脊肌阻滞或胸椎旁阻滞,选择T 5横突水平,注射0.5%罗哌卡因0.4 ml/kg。两组术毕皆采用舒芬太尼行PCIA。记录神经阻滞的操作时间、阻滞起效时间、阻滞平面,术中呼吸抑制、刺破胸膜、血管损伤情况,术中瑞芬太尼的用量,术后PCA首次按压时间,24 h内PCA有效按压次数,术后2、6、12、24、48 h的疼痛NRS评分,术后恶心、呕吐、皮肤瘙痒等并发症的发生情况。结果与TPVB组比较,ESPB组神经阻滞操作时间明显缩短,阻滞起效时间明显延长,阻滞平面明显扩大,术后PCA首次按压时间明显缩短,24 h内PCA有效按压次数明显增多(P<0.05)。两组术中均未发生呼吸抑制、刺破胸膜、血管损伤等并发症。两组术中瑞芬太尼用量、术后不同时点疼痛NRS评分、术后并发症差异无统计学意义。结论ESPB和TPVB用于乳腺癌根治术的围术期镇痛时,都能取得满意的效果,TPVB阻滞时间持久,ESPB阻滞平面范围更大,操作更简便。
Objective To compare the effect of erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in radical mastectomy.Methods Eighty women undergoing radical mastectomy surgery,aged 28-65 years,BMI<35 kg/m 2,ASA physical statusⅠorⅡ,were randomly divided into two groups(n=40):TPVB group and ESPB group.Before anesthesia induction,group TPVB and group ESPB received ultrasound-guided thoracic paravertebral block or erector spinae plane block,T 5 level,0.5%ropivacaine 0.4 ml/kg,respectively.Then,laryngeal mask general anesthesia was conducted.Remifentanil and propofol were injected intraoperatively to maintain the anesthesia.All patients received PCIA after operation.The pain score and complications were followed up 2,6,12,24,48 h after procedure.The surgery duration,operation time of block,onset time,blocking range,puncture of pleura and vascular injury during operation,consumption of remifentanil during operation,pain NRS score at each time point after operation,PCA pressing times within 24 h,nausea,vomiting,skin itching,the occurrence of respiratory depression and other complications were recorded.Results Compared with group TPVB,group ESPB had shorter operation time and longer onset time of nerve block,more segments involved in block plane and more PCA pressing times within 24 h(P<0.05).No complications such as respiratory depression,puncture of pleura and vascular injury occurred in the two groups.There was no significant difference between the two groups in operation time,remifentanil consumption,pain NRS score at each time point and postoperative complication rate.Conclusion Both erector spinal plane block and thoracic paravertebral nerve block can achieve satisfactory results in the perioperative analgesia of radical mastectomy,but compared with thoracic paravertebral nerve block,the plane block of erector spinal muscle is wider and easier to operate.
作者
魏鑫
杨凯
高晓秋
马武华
WEI Xin;YANG Kai;GAO Xiaoqiu;MA Wuhua(The First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第9期871-875,共5页
Journal of Clinical Anesthesiology
关键词
胸椎旁神经阻滞
竖脊肌平面阻滞
乳腺癌根治术
术后镇痛
Thoracic paravertebral block
Erector spinae plane block
Radical mastectomy
Postoperative analgesia
